|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
IP
|
$6,912.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,382.40 |
| Max. Negotiated Rate |
$5,875.20 |
| Rate for Payer: Adventist Health Commercial |
$1,382.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,838.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.80
|
| Rate for Payer: Galaxy Health WC |
$5,875.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,389.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,078.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.88
|
| Rate for Payer: Multiplan Commercial |
$5,529.60
|
| Rate for Payer: Networks By Design Commercial |
$4,492.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,875.20
|
|
|
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 |
$24.82
|
| Rate for Payer: Blue Shield of California Commercial |
$31.53
|
| Rate for Payer: Blue Shield of California Commercial |
$20.79
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| 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 |
$26.65
|
| 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 |
$24.82
|
| Rate for Payer: Blue Shield of California Commercial |
$31.53
|
| Rate for Payer: Blue Shield of California Commercial |
$20.79
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| 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 |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| 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 |
$26.65
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| 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 |
$118.30
|
| 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 |
$110.16
|
| Rate for Payer: Blue Shield of California Commercial |
$92.27
|
| Rate for Payer: Blue Shield of California Commercial |
$139.96
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| 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 |
$110.16
|
| Rate for Payer: Blue Shield of California Commercial |
$92.27
|
| Rate for Payer: Blue Shield of California Commercial |
$139.96
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| 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 |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| 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 |
$118.30
|
| 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 |
$9.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.90
|
| 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 |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.48
|
| 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
|
$120.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$227.89 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| 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 Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$102.80
|
| Rate for Payer: Blue Shield of California Commercial |
$55.32
|
| Rate for Payer: Blue Shield of California Commercial |
$155.43
|
| Rate for Payer: Blue Shield of California Commercial |
$83.64
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.84
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| 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 Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| 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 Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| 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 Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
| 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 |
$100.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$85.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.82
|
| 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 |
$87.93
|
| 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: 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: 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 |
$81.88
|
| Rate for Payer: Blue Shield of California Commercial |
$104.03
|
| Rate for Payer: Blue Shield of California Commercial |
$68.59
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$85.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.82
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.06
|
| 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 |
$97.02
|
| 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 |
$90.35
|
| Rate for Payer: Blue Shield of California Commercial |
$114.78
|
| Rate for Payer: Blue Shield of California Commercial |
$75.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.06
|
| 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
|
IP
|
$109.44
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$69.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.57
|
| 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 |
$71.14
|
| 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 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 |
$66.24
|
| Rate for Payer: Blue Shield of California Commercial |
$55.49
|
| Rate for Payer: Blue Shield of California Commercial |
$84.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$69.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.57
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$90.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.72
|
| 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 |
$92.23
|
| 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 |
$85.89
|
| Rate for Payer: Blue Shield of California Commercial |
$109.11
|
| Rate for Payer: Blue Shield of California Commercial |
$71.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$90.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.72
|
| 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 |
$57.73
|
| Rate for Payer: Blue Shield of California Commercial |
$48.36
|
| Rate for Payer: Blue Shield of California Commercial |
$73.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| 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 |
$62.00
|
| 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 |
$57.73
|
| Rate for Payer: Blue Shield of California Commercial |
$48.36
|
| Rate for Payer: Blue Shield of California Commercial |
$73.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| 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 |
$62.00
|
| 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
|
|
