|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
OP
|
$159.46
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.27 |
| Max. Negotiated Rate |
$135.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$94.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.01
|
| Rate for Payer: Blue Distinction Transplant |
$95.68
|
| Rate for Payer: Blue Shield of California Commercial |
$117.52
|
| Rate for Payer: Blue Shield of California EPN |
$93.12
|
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Cigna of CA HMO |
$102.05
|
| Rate for Payer: Cigna of CA PPO |
$118.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.54
|
| Rate for Payer: Dignity Health Media |
$135.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.78
|
| Rate for Payer: Galaxy Health WC |
$135.54
|
| Rate for Payer: Global Benefits Group Commercial |
$95.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$119.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$127.57
|
| Rate for Payer: Networks By Design Commercial |
$103.65
|
| Rate for Payer: Prime Health Services Commercial |
$135.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.73
|
| Rate for Payer: United Healthcare All Other HMO |
$79.73
|
| Rate for Payer: United Healthcare HMO Rider |
$79.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$135.54
|
| Rate for Payer: Vantage Medical Group Senior |
$135.54
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
IP
|
$159.46
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.27 |
| Max. Negotiated Rate |
$135.54 |
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.78
|
| Rate for Payer: Galaxy Health WC |
$135.54
|
| Rate for Payer: Global Benefits Group Commercial |
$95.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$127.57
|
| Rate for Payer: Networks By Design Commercial |
$103.65
|
| Rate for Payer: Prime Health Services Commercial |
$135.54
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$83.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: Blue Distinction Transplant |
$58.96
|
| Rate for Payer: Blue Shield of California Commercial |
$72.42
|
| Rate for Payer: Blue Shield of California EPN |
$57.39
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cigna of CA HMO |
$62.89
|
| Rate for Payer: Cigna of CA PPO |
$72.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.53
|
| Rate for Payer: Dignity Health Media |
$83.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$78.62
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.14
|
| Rate for Payer: United Healthcare All Other HMO |
$49.14
|
| Rate for Payer: United Healthcare HMO Rider |
$49.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.53
|
| Rate for Payer: Vantage Medical Group Senior |
$83.53
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$83.53 |
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$78.62
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
OP
|
$117.12
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.78
|
| Rate for Payer: Blue Distinction Transplant |
$70.27
|
| Rate for Payer: Blue Shield of California Commercial |
$86.32
|
| Rate for Payer: Blue Shield of California EPN |
$68.40
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Cigna of CA HMO |
$74.96
|
| Rate for Payer: Cigna of CA PPO |
$86.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.55
|
| Rate for Payer: Dignity Health Media |
$99.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$87.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.11
|
| Rate for Payer: Multiplan Commercial |
$93.70
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Other HMO |
$58.56
|
| Rate for Payer: United Healthcare HMO Rider |
$58.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Vantage Medical Group Senior |
$99.55
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
IP
|
$117.12
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.11
|
| Rate for Payer: Multiplan Commercial |
$93.70
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$83.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: Blue Distinction Transplant |
$58.96
|
| Rate for Payer: Blue Shield of California Commercial |
$72.42
|
| Rate for Payer: Blue Shield of California EPN |
$57.39
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cigna of CA HMO |
$62.89
|
| Rate for Payer: Cigna of CA PPO |
$72.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.53
|
| Rate for Payer: Dignity Health Media |
$83.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$78.62
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.14
|
| Rate for Payer: United Healthcare All Other HMO |
$49.14
|
| Rate for Payer: United Healthcare HMO Rider |
$49.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.53
|
| Rate for Payer: Vantage Medical Group Senior |
$83.53
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$83.53 |
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$78.62
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
|
IP
|
$182.21
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.73 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.73
|
| Rate for Payer: Multiplan Commercial |
$145.77
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
|
OP
|
$182.21
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.56
|
| Rate for Payer: Blue Distinction Transplant |
$109.33
|
| Rate for Payer: Blue Shield of California Commercial |
$134.29
|
| Rate for Payer: Blue Shield of California EPN |
$106.41
|
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Cigna of CA HMO |
$116.61
|
| Rate for Payer: Cigna of CA PPO |
$134.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.88
|
| Rate for Payer: Dignity Health Media |
$154.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$136.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.73
|
| Rate for Payer: Multiplan Commercial |
$145.77
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.10
|
| Rate for Payer: United Healthcare All Other HMO |
$91.10
|
| Rate for Payer: United Healthcare HMO Rider |
$91.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.88
|
| Rate for Payer: Vantage Medical Group Senior |
$154.88
|
|
|
HC TRAY CATH SLCN 18FR URN MTR
|
Facility
|
OP
|
$117.12
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.78
|
| Rate for Payer: Blue Distinction Transplant |
$70.27
|
| Rate for Payer: Blue Shield of California Commercial |
$86.32
|
| Rate for Payer: Blue Shield of California EPN |
$68.40
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Cigna of CA HMO |
$74.96
|
| Rate for Payer: Cigna of CA PPO |
$86.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.55
|
| Rate for Payer: Dignity Health Media |
$99.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$87.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.11
|
| Rate for Payer: Multiplan Commercial |
$93.70
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Other HMO |
$58.56
|
| Rate for Payer: United Healthcare HMO Rider |
$58.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Vantage Medical Group Senior |
$99.55
|
|
|
HC TRAY CATH SLCN 18FR URN MTR
|
Facility
|
IP
|
$117.12
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.11
|
| Rate for Payer: Multiplan Commercial |
$93.70
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
|
|
HC TRAY FOLEY URN MTR NO CATH
|
Facility
|
IP
|
$113.24
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
901698796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$96.25 |
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.30
|
| Rate for Payer: Galaxy Health WC |
$96.25
|
| Rate for Payer: Global Benefits Group Commercial |
$67.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$90.59
|
| Rate for Payer: Networks By Design Commercial |
$73.61
|
| Rate for Payer: Prime Health Services Commercial |
$96.25
|
|
|
HC TRAY FOLEY URN MTR NO CATH
|
Facility
|
OP
|
$113.24
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
901698796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$96.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.47
|
| Rate for Payer: Blue Distinction Transplant |
$67.94
|
| Rate for Payer: Blue Shield of California Commercial |
$83.46
|
| Rate for Payer: Blue Shield of California EPN |
$66.13
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cigna of CA HMO |
$72.47
|
| Rate for Payer: Cigna of CA PPO |
$83.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.25
|
| Rate for Payer: Dignity Health Media |
$96.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.30
|
| Rate for Payer: Galaxy Health WC |
$96.25
|
| Rate for Payer: Global Benefits Group Commercial |
$67.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$90.59
|
| Rate for Payer: Networks By Design Commercial |
$73.61
|
| Rate for Payer: Prime Health Services Commercial |
$96.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.62
|
| Rate for Payer: United Healthcare All Other HMO |
$56.62
|
| Rate for Payer: United Healthcare HMO Rider |
$56.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Vantage Medical Group Senior |
$96.25
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
IP
|
$1,428.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.72 |
| Max. Negotiated Rate |
$1,213.80 |
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.72
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
OP
|
$1,428.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$856.80
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,071.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$714.00
|
| Rate for Payer: United Healthcare All Other HMO |
$714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$714.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$714.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
OP
|
$22,663.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$19,263.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,597.80
|
| Rate for Payer: Cash Price |
$10,198.35
|
| Rate for Payer: Cash Price |
$10,198.35
|
| Rate for Payer: Cash Price |
$10,198.35
|
| Rate for Payer: Cigna of CA PPO |
$16,770.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$19,263.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13,597.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,997.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,116.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,439.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$18,130.40
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$14,730.95
|
| Rate for Payer: Prime Health Services Commercial |
$19,263.55
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,597.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,331.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11,331.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11,331.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,331.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
IP
|
$22,663.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,439.12 |
| Max. Negotiated Rate |
$19,263.55 |
| Rate for Payer: Cash Price |
$10,198.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,065.20
|
| Rate for Payer: Galaxy Health WC |
$19,263.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13,597.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,116.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,634.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,439.12
|
| Rate for Payer: Multiplan Commercial |
$18,130.40
|
| Rate for Payer: Networks By Design Commercial |
$14,730.95
|
| Rate for Payer: Prime Health Services Commercial |
$19,263.55
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.68 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,069.20
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,336.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$891.00
|
| Rate for Payer: United Healthcare All Other HMO |
$891.00
|
| Rate for Payer: United Healthcare HMO Rider |
$891.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$891.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT HIP SOCKET FRACTURE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 27222
|
| Hospital Charge Code |
900507222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$585.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$378.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$413.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA PPO |
$509.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$585.65
|
| Rate for Payer: Dignity Health Media |
$585.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$275.60
|
| Rate for Payer: Galaxy Health WC |
$585.65
|
| Rate for Payer: Global Benefits Group Commercial |
$413.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$516.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$551.20
|
| Rate for Payer: Networks By Design Commercial |
$447.85
|
| Rate for Payer: Prime Health Services Commercial |
$585.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$413.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$585.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.65
|
| Rate for Payer: Vantage Medical Group Senior |
$585.65
|
|
|
HC TREAT HIP SOCKET FRACTURE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 27222
|
| Hospital Charge Code |
900507222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: Galaxy Health WC |
$585.65
|
| Rate for Payer: Global Benefits Group Commercial |
$413.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$551.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$585.65
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$349.80
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$437.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
OP
|
$9,424.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,654.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cigna of CA PPO |
$6,973.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$8,010.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,654.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,068.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,285.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,261.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$7,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,125.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,010.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,654.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
