|
HC INTRO SHEATH 8FR ADULT
|
Facility
|
OP
|
$55.35
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$47.05 |
| Rate for Payer: Adventist Health Commercial |
$11.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.99
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cigna of CA HMO |
$35.42
|
| Rate for Payer: Cigna of CA PPO |
$40.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.14
|
| Rate for Payer: EPIC Health Plan Senior |
$22.14
|
| Rate for Payer: Galaxy Health WC |
$47.05
|
| Rate for Payer: Global Benefits Group Commercial |
$33.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.74
|
| Rate for Payer: Multiplan Commercial |
$44.28
|
| Rate for Payer: Networks By Design Commercial |
$35.98
|
| Rate for Payer: Prime Health Services Commercial |
$47.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.68
|
| Rate for Payer: United Healthcare All Other HMO |
$27.68
|
| Rate for Payer: United Healthcare HMO Rider |
$27.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.05
|
| Rate for Payer: Vantage Medical Group Senior |
$47.05
|
|
|
HC INTRO SHEATH 8FR ADULT
|
Facility
|
IP
|
$55.35
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$47.05 |
| Rate for Payer: Adventist Health Commercial |
$11.07
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.14
|
| Rate for Payer: EPIC Health Plan Senior |
$22.14
|
| Rate for Payer: Galaxy Health WC |
$47.05
|
| Rate for Payer: Global Benefits Group Commercial |
$33.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$44.28
|
| Rate for Payer: Networks By Design Commercial |
$35.98
|
| Rate for Payer: Prime Health Services Commercial |
$47.05
|
|
|
HC INTRO SPINAL BD 406999
|
Facility
|
OP
|
$40.34
|
|
| Hospital Charge Code |
901604254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Adventist Health Commercial |
$8.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.77
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cigna of CA HMO |
$25.82
|
| Rate for Payer: Cigna of CA PPO |
$29.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.14
|
| Rate for Payer: EPIC Health Plan Senior |
$16.14
|
| Rate for Payer: Galaxy Health WC |
$34.29
|
| Rate for Payer: Global Benefits Group Commercial |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| Rate for Payer: Multiplan Commercial |
$32.27
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Prime Health Services Commercial |
$34.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.17
|
| Rate for Payer: United Healthcare All Other HMO |
$20.17
|
| Rate for Payer: United Healthcare HMO Rider |
$20.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.29
|
|
|
HC INTRO SPINAL BD 406999
|
Facility
|
IP
|
$40.34
|
|
| Hospital Charge Code |
901604254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Adventist Health Commercial |
$8.07
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.14
|
| Rate for Payer: EPIC Health Plan Senior |
$16.14
|
| Rate for Payer: Galaxy Health WC |
$34.29
|
| Rate for Payer: Global Benefits Group Commercial |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.68
|
| Rate for Payer: Multiplan Commercial |
$32.27
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Prime Health Services Commercial |
$34.29
|
|
|
HC INTRO TRACH PERCUT 7.5,8.5,9.0
|
Facility
|
OP
|
$1,766.95
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.39 |
| Max. Negotiated Rate |
$1,501.91 |
| Rate for Payer: Adventist Health Commercial |
$353.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,158.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,501.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$971.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,325.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,085.08
|
| Rate for Payer: Cash Price |
$971.82
|
| Rate for Payer: Cigna of CA HMO |
$1,130.85
|
| Rate for Payer: Cigna of CA PPO |
$1,307.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,501.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,501.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,501.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$706.78
|
| Rate for Payer: EPIC Health Plan Senior |
$706.78
|
| Rate for Payer: Galaxy Health WC |
$1,501.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1,060.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,178.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,093.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,236.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,236.87
|
| Rate for Payer: Multiplan Commercial |
$1,413.56
|
| Rate for Payer: Networks By Design Commercial |
$1,148.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,060.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,060.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$883.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.48
|
| Rate for Payer: United Healthcare HMO Rider |
$883.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$883.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,501.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,501.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1,501.91
|
|
|
HC INTRO TRACH PERCUT 7.5,8.5,9.0
|
Facility
|
IP
|
$1,766.95
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.39 |
| Max. Negotiated Rate |
$1,501.91 |
| Rate for Payer: Adventist Health Commercial |
$353.39
|
| Rate for Payer: Cash Price |
$971.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$706.78
|
| Rate for Payer: EPIC Health Plan Senior |
$706.78
|
| Rate for Payer: Galaxy Health WC |
$1,501.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1,060.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,178.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,093.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.07
|
| Rate for Payer: Multiplan Commercial |
$1,413.56
|
| Rate for Payer: Networks By Design Commercial |
$1,148.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.91
|
|
|
HC INTRO TRACH PERCUTANEOUS 7.5MM
|
Facility
|
IP
|
$2,176.77
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.35 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Adventist Health Commercial |
$435.35
|
| Rate for Payer: Cash Price |
$1,197.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.71
|
| Rate for Payer: EPIC Health Plan Senior |
$870.71
|
| Rate for Payer: Galaxy Health WC |
$1,850.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,451.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.42
|
| Rate for Payer: Multiplan Commercial |
$1,741.42
|
| Rate for Payer: Networks By Design Commercial |
$1,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.25
|
|
|
HC INTRO TRACH PERCUTANEOUS 7.5MM
|
Facility
|
OP
|
$2,176.77
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.35 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Adventist Health Commercial |
$435.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,427.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,850.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,632.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,336.75
|
| Rate for Payer: Cash Price |
$1,197.22
|
| Rate for Payer: Cigna of CA HMO |
$1,393.13
|
| Rate for Payer: Cigna of CA PPO |
$1,610.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,850.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,850.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,850.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.71
|
| Rate for Payer: EPIC Health Plan Senior |
$870.71
|
| Rate for Payer: Galaxy Health WC |
$1,850.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,451.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,523.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,523.74
|
| Rate for Payer: Multiplan Commercial |
$1,741.42
|
| Rate for Payer: Networks By Design Commercial |
$1,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,850.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,850.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,850.25
|
|
|
HC INTRO TRACH PERCUTANEOUS 8.5MM
|
Facility
|
OP
|
$2,176.77
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.35 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Adventist Health Commercial |
$435.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,427.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,850.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,632.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,336.75
|
| Rate for Payer: Cash Price |
$1,197.22
|
| Rate for Payer: Cigna of CA HMO |
$1,393.13
|
| Rate for Payer: Cigna of CA PPO |
$1,610.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,850.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,850.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,850.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.71
|
| Rate for Payer: EPIC Health Plan Senior |
$870.71
|
| Rate for Payer: Galaxy Health WC |
$1,850.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,451.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,523.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,523.74
|
| Rate for Payer: Multiplan Commercial |
$1,741.42
|
| Rate for Payer: Networks By Design Commercial |
$1,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,850.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,850.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,850.25
|
|
|
HC INTRO TRACH PERCUTANEOUS 8.5MM
|
Facility
|
IP
|
$2,176.77
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.35 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Adventist Health Commercial |
$435.35
|
| Rate for Payer: Cash Price |
$1,197.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.71
|
| Rate for Payer: EPIC Health Plan Senior |
$870.71
|
| Rate for Payer: Galaxy Health WC |
$1,850.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,451.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.42
|
| Rate for Payer: Multiplan Commercial |
$1,741.42
|
| Rate for Payer: Networks By Design Commercial |
$1,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.25
|
|
|
HC INTRO TRACH PERQ COOK 15GA
|
Facility
|
IP
|
$2,194.48
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901604420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$1,865.31 |
| Rate for Payer: Adventist Health Commercial |
$438.90
|
| Rate for Payer: Cash Price |
$1,206.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.79
|
| Rate for Payer: EPIC Health Plan Senior |
$877.79
|
| Rate for Payer: Galaxy Health WC |
$1,865.31
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$836.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.68
|
| Rate for Payer: Multiplan Commercial |
$1,755.58
|
| Rate for Payer: Networks By Design Commercial |
$1,426.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.31
|
|
|
HC INTRO TRACH PERQ COOK 15GA
|
Facility
|
OP
|
$2,194.48
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901604420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$1,865.31 |
| Rate for Payer: Adventist Health Commercial |
$438.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,439.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,865.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,347.63
|
| Rate for Payer: Cash Price |
$1,206.96
|
| Rate for Payer: Cigna of CA HMO |
$1,404.47
|
| Rate for Payer: Cigna of CA PPO |
$1,623.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,865.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,865.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,865.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.79
|
| Rate for Payer: EPIC Health Plan Senior |
$877.79
|
| Rate for Payer: Galaxy Health WC |
$1,865.31
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$836.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,536.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,536.14
|
| Rate for Payer: Multiplan Commercial |
$1,755.58
|
| Rate for Payer: Networks By Design Commercial |
$1,426.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,097.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,097.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,865.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,865.31
|
| Rate for Payer: Vantage Medical Group Senior |
$1,865.31
|
|
|
HC INT SKIN BARRIER ROLL 10"X144"
|
Facility
|
OP
|
$341.18
|
|
| Hospital Charge Code |
901698564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Adventist Health Commercial |
$68.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$223.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.52
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cigna of CA HMO |
$218.36
|
| Rate for Payer: Cigna of CA PPO |
$252.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$290.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.47
|
| Rate for Payer: EPIC Health Plan Senior |
$136.47
|
| Rate for Payer: Galaxy Health WC |
$290.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$238.83
|
| Rate for Payer: Multiplan Commercial |
$272.94
|
| Rate for Payer: Networks By Design Commercial |
$221.77
|
| Rate for Payer: Prime Health Services Commercial |
$290.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.59
|
| Rate for Payer: United Healthcare All Other HMO |
$170.59
|
| Rate for Payer: United Healthcare HMO Rider |
$170.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.00
|
| Rate for Payer: Vantage Medical Group Senior |
$290.00
|
|
|
HC INT SKIN BARRIER ROLL 10"X144"
|
Facility
|
IP
|
$341.18
|
|
| Hospital Charge Code |
901698564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Adventist Health Commercial |
$68.24
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.47
|
| Rate for Payer: EPIC Health Plan Senior |
$136.47
|
| Rate for Payer: Galaxy Health WC |
$290.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$272.94
|
| Rate for Payer: Networks By Design Commercial |
$221.77
|
| Rate for Payer: Prime Health Services Commercial |
$290.00
|
|
|
HC INT SKIN BARRIER SHEET 10"X36"
|
Facility
|
IP
|
$259.56
|
|
| Hospital Charge Code |
901698565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$220.63 |
| Rate for Payer: Adventist Health Commercial |
$51.91
|
| Rate for Payer: Cash Price |
$142.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.82
|
| Rate for Payer: EPIC Health Plan Senior |
$103.82
|
| Rate for Payer: Galaxy Health WC |
$220.63
|
| Rate for Payer: Global Benefits Group Commercial |
$155.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$207.65
|
| Rate for Payer: Networks By Design Commercial |
$168.71
|
| Rate for Payer: Prime Health Services Commercial |
$220.63
|
|
|
HC INT SKIN BARRIER SHEET 10"X36"
|
Facility
|
OP
|
$259.56
|
|
| Hospital Charge Code |
901698565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$220.63 |
| Rate for Payer: Adventist Health Commercial |
$51.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.40
|
| Rate for Payer: Cash Price |
$142.76
|
| Rate for Payer: Cigna of CA HMO |
$166.12
|
| Rate for Payer: Cigna of CA PPO |
$192.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.82
|
| Rate for Payer: EPIC Health Plan Senior |
$103.82
|
| Rate for Payer: Galaxy Health WC |
$220.63
|
| Rate for Payer: Global Benefits Group Commercial |
$155.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.69
|
| Rate for Payer: Multiplan Commercial |
$207.65
|
| Rate for Payer: Networks By Design Commercial |
$168.71
|
| Rate for Payer: Prime Health Services Commercial |
$220.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.78
|
| Rate for Payer: United Healthcare All Other HMO |
$129.78
|
| Rate for Payer: United Healthcare HMO Rider |
$129.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.63
|
| Rate for Payer: Vantage Medical Group Senior |
$220.63
|
|
|
HC INTUSSUSCEPTION REDUCTION SYST
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
909001061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.90
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO |
$67.50
|
| Rate for Payer: United Healthcare HMO Rider |
$67.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC INTUSSUSCEPTION REDUCTION SYST
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
909001061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC IOC TOUCH-PREP ADDL SITE PG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800222
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$99.15 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.15
|
| Rate for Payer: Blue Shield of California Commercial |
$34.12
|
| Rate for Payer: Blue Shield of California EPN |
$22.54
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC IOC TOUCH-PREP ADDL SITE PG
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800222
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC IOC TOUCH-PREP INITIAL PG
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800221
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC IOC TOUCH-PREP INITIAL PG
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800221
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$619.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.12
|
| Rate for Payer: Blue Shield of California Commercial |
$631.54
|
| Rate for Payer: Blue Shield of California EPN |
$417.25
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC IONTOPHORESIS 15 MIN MCARE COMM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900407033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
