|
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 |
$135.00
|
| 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 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 |
$135.00
|
| 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 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 |
$60.88
|
| Rate for Payer: Cash Price |
$60.88
|
| 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 |
$60.88
|
| 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
|
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 |
$67.17
|
| 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 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 |
$67.17
|
| Rate for Payer: Cash Price |
$67.17
|
| 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 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 |
$49.25
|
| 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 |
$49.25
|
| Rate for Payer: Cash Price |
$49.25
|
| 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 |
$63.85
|
| Rate for Payer: Cash Price |
$63.85
|
| 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
|
|
|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
OP
|
$141.89
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$120.61 |
| Rate for Payer: Adventist Health Commercial |
$58.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.18
|
| Rate for Payer: Blue Shield of California Commercial |
$104.71
|
| Rate for Payer: Blue Shield of California EPN |
$68.96
|
| Rate for Payer: Cash Price |
$63.85
|
| Rate for Payer: Cigna of CA HMO |
$99.32
|
| Rate for Payer: Cigna of CA PPO |
$99.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.61
|
| 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 Medicare Advantage |
$87.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.32
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$85.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.13
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.61
|
| Rate for Payer: Vantage Medical Group Senior |
$120.61
|
|
|
HC MIAMI JR REPLCMNT PAD 6-12YR
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$39.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.24
|
| Rate for Payer: Blue Shield of California Commercial |
$70.39
|
| Rate for Payer: Blue Shield of California EPN |
$46.35
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC MIAMI JR REPLCMNT PAD 6-12YR
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
|
|
HC MIAMI JR REPLCMNT PAD 6MO-2YR
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605413
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
|
|
HC MIAMI JR REPLCMNT PAD 6MO-2YR
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605413
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$39.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.24
|
| Rate for Payer: Blue Shield of California Commercial |
$70.39
|
| Rate for Payer: Blue Shield of California EPN |
$46.35
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.01
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.60
|
| Rate for Payer: Blue Shield of California Commercial |
$518.08
|
| Rate for Payer: Blue Shield of California EPN |
$341.17
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC MICROALBUMIN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$57.19 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.19
|
| Rate for Payer: Blue Shield of California Commercial |
$41.48
|
| Rate for Payer: Blue Shield of California EPN |
$27.40
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC MICROCATH DIREXION
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.40
|
| Rate for Payer: Galaxy Health WC |
$2,597.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,833.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,891.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.44
|
| Rate for Payer: Multiplan Commercial |
$2,444.80
|
| Rate for Payer: Networks By Design Commercial |
$1,986.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,597.60
|
|
|
HC MICROCATH DIREXION
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,004.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,292.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.69
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna of CA HMO |
$1,955.84
|
| Rate for Payer: Cigna of CA PPO |
$2,261.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,597.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.40
|
| Rate for Payer: Galaxy Health WC |
$2,597.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,833.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,891.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,139.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,139.20
|
| Rate for Payer: Multiplan Commercial |
$2,444.80
|
| Rate for Payer: Networks By Design Commercial |
$1,986.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,597.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,833.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,833.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,597.60
|
|
|
HC MICROCATHETER
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC MICROCATHETER
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC MICROCATH MAGIC
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,247.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,864.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.17
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
