|
HC MERO ETEST
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC MERO ETEST
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$167.37 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.37
|
| Rate for Payer: Blue Shield of California Commercial |
$46.83
|
| Rate for Payer: Blue Shield of California EPN |
$30.94
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.75
|
| Rate for Payer: Blue Shield of California Commercial |
$30.26
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.75
|
| Rate for Payer: Blue Shield of California Commercial |
$30.26
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.41
|
| Rate for Payer: Blue Shield of California Commercial |
$134.32
|
| Rate for Payer: Blue Shield of California EPN |
$88.45
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.41
|
| Rate for Payer: Blue Shield of California Commercial |
$134.32
|
| Rate for Payer: Blue Shield of California EPN |
$88.45
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC METHEMOGLOBIN CH
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900912183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC METHEMOGLOBIN CH
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900912183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.07
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.99
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$98.57
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Senior |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC MFN DRUG ADD-ON, PER DOSE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT M1145
|
| Hospital Charge Code |
901700053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$221.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC MFN DRUG ADD-ON, PER DOSE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT M1145
|
| Hospital Charge Code |
901700053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.23
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC MIAMI J REPLCMNT PAD SHORT
|
Facility
|
IP
|
$135.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$94.70
|
| Rate for Payer: Cigna of CA PPO |
$94.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Senior |
$54.11
|
| Rate for Payer: Galaxy Health WC |
$114.99
|
| Rate for Payer: Global Benefits Group Commercial |
$81.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.47
|
| Rate for Payer: Multiplan Commercial |
$108.22
|
| Rate for Payer: Networks By Design Commercial |
$67.64
|
| Rate for Payer: Prime Health Services Commercial |
$114.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$49.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.30
|
|
|
HC MIAMI J REPLCMNT PAD SHORT
|
Facility
|
OP
|
$135.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$114.99 |
| Rate for Payer: Adventist Health Commercial |
$55.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.35
|
| Rate for Payer: Blue Shield of California Commercial |
$99.84
|
| Rate for Payer: Blue Shield of California EPN |
$65.75
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$94.70
|
| Rate for Payer: Cigna of CA PPO |
$94.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Senior |
$54.11
|
| Rate for Payer: Galaxy Health WC |
$114.99
|
| Rate for Payer: Global Benefits Group Commercial |
$81.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.70
|
| Rate for Payer: Multiplan Commercial |
$108.22
|
| Rate for Payer: Networks By Design Commercial |
$67.64
|
| Rate for Payer: Prime Health Services Commercial |
$114.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$49.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.99
|
| Rate for Payer: Vantage Medical Group Senior |
$114.99
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
IP
|
$149.26
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.09
|
| Rate for Payer: Cash Price |
$82.09
|
| Rate for Payer: Cigna of CA HMO |
$104.48
|
| Rate for Payer: Cigna of CA PPO |
$104.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Senior |
$59.70
|
| Rate for Payer: Galaxy Health WC |
$126.87
|
| Rate for Payer: Global Benefits Group Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.82
|
| Rate for Payer: Multiplan Commercial |
$119.41
|
| Rate for Payer: Networks By Design Commercial |
$74.63
|
| Rate for Payer: Prime Health Services Commercial |
$126.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.02
|
| Rate for Payer: United Healthcare All Other HMO |
$54.52
|
| Rate for Payer: United Healthcare HMO Rider |
$53.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.88
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
OP
|
$149.26
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$126.87 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.45
|
| Rate for Payer: Blue Shield of California Commercial |
$110.15
|
| Rate for Payer: Blue Shield of California EPN |
$72.54
|
| Rate for Payer: Cash Price |
$82.09
|
| Rate for Payer: Cigna of CA HMO |
$104.48
|
| Rate for Payer: Cigna of CA PPO |
$104.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Senior |
$59.70
|
| Rate for Payer: Galaxy Health WC |
$126.87
|
| Rate for Payer: Global Benefits Group Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.48
|
| Rate for Payer: Multiplan Commercial |
$119.41
|
| Rate for Payer: Networks By Design Commercial |
$74.63
|
| Rate for Payer: Prime Health Services Commercial |
$126.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.02
|
| Rate for Payer: United Healthcare All Other HMO |
$54.52
|
| Rate for Payer: United Healthcare HMO Rider |
$53.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.87
|
| Rate for Payer: Vantage Medical Group Senior |
$126.87
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
OP
|
$109.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$93.02 |
| Rate for Payer: Adventist Health Commercial |
$44.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.39
|
| Rate for Payer: Blue Shield of California Commercial |
$80.77
|
| Rate for Payer: Blue Shield of California EPN |
$53.19
|
| Rate for Payer: Cash Price |
$60.19
|
| Rate for Payer: Cigna of CA HMO |
$76.61
|
| Rate for Payer: Cigna of CA PPO |
$76.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.78
|
| Rate for Payer: EPIC Health Plan Senior |
$43.78
|
| Rate for Payer: Galaxy Health WC |
$93.02
|
| Rate for Payer: Global Benefits Group Commercial |
$65.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.61
|
| Rate for Payer: Multiplan Commercial |
$87.55
|
| Rate for Payer: Networks By Design Commercial |
$54.72
|
| Rate for Payer: Prime Health Services Commercial |
$93.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.07
|
| Rate for Payer: United Healthcare All Other HMO |
$39.98
|
| Rate for Payer: United Healthcare HMO Rider |
$39.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.02
|
| Rate for Payer: Vantage Medical Group Senior |
$93.02
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.19
|
| Rate for Payer: Cash Price |
$60.19
|
| Rate for Payer: Cigna of CA HMO |
$76.61
|
| Rate for Payer: Cigna of CA PPO |
$76.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.78
|
| Rate for Payer: EPIC Health Plan Senior |
$43.78
|
| Rate for Payer: Galaxy Health WC |
$93.02
|
| Rate for Payer: Global Benefits Group Commercial |
$65.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.27
|
| Rate for Payer: Multiplan Commercial |
$87.55
|
| Rate for Payer: Networks By Design Commercial |
$54.72
|
| Rate for Payer: Prime Health Services Commercial |
$93.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.07
|
| Rate for Payer: United Healthcare All Other HMO |
$39.98
|
| Rate for Payer: United Healthcare HMO Rider |
$39.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.84
|
|
|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
IP
|
$141.89
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$78.04
|
| Rate for Payer: Cash Price |
$78.04
|
| Rate for Payer: Cigna of CA HMO |
$99.32
|
| Rate for Payer: Cigna of CA PPO |
$99.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.76
|
| Rate for Payer: EPIC Health Plan Senior |
$56.76
|
| Rate for Payer: Galaxy Health WC |
$120.61
|
| Rate for Payer: Global Benefits Group Commercial |
$85.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.05
|
| Rate for Payer: Multiplan Commercial |
$113.51
|
| Rate for Payer: Networks By Design Commercial |
$70.94
|
| Rate for Payer: Prime Health Services Commercial |
$120.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.25
|
| Rate for Payer: United Healthcare All Other HMO |
$51.83
|
| Rate for Payer: United Healthcare HMO Rider |
$50.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.47
|
|
