|
HC OCCLUSION CATHETER
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$368.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$247.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,049.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$679.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$926.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$555.75
|
| Rate for Payer: Cash Price |
$555.75
|
| Rate for Payer: Cigna of CA HMO |
$790.40
|
| Rate for Payer: Cigna of CA PPO |
$913.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,049.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,049.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,049.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$494.00
|
| Rate for Payer: Galaxy Health WC |
$1,049.75
|
| Rate for Payer: Global Benefits Group Commercial |
$741.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$764.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$864.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$864.50
|
| Rate for Payer: Multiplan Commercial |
$988.00
|
| Rate for Payer: Networks By Design Commercial |
$802.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,049.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$741.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,049.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,049.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,049.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
IP
|
$1,235.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Adventist Health Commercial |
$247.00
|
| Rate for Payer: Cash Price |
$555.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$494.00
|
| Rate for Payer: Galaxy Health WC |
$1,049.75
|
| Rate for Payer: Global Benefits Group Commercial |
$741.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$764.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.40
|
| Rate for Payer: Multiplan Commercial |
$988.00
|
| Rate for Payer: Networks By Design Commercial |
$802.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,049.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$577.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO |
$672.00
|
| Rate for Payer: Cigna of CA PPO |
$777.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$892.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$892.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$892.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$649.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$892.50
|
| Rate for Payer: Vantage Medical Group Senior |
$892.50
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$649.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.91
|
| Rate for Payer: EPIC Health Plan Senior |
$4.38
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.55
|
| Rate for Payer: United Healthcare HMO Rider |
$3.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$31.39 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$5.35
|
| Rate for Payer: Blue Shield of California EPN |
$3.54
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO |
$5.12
|
| Rate for Payer: Cigna of CA PPO |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.32
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$31.39 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.32
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.14
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.88
|
| Rate for Payer: EPIC Health Plan Senior |
$79.17
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.09
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$79.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.09
|
| Rate for Payer: Vantage Medical Group Senior |
$79.17
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$241.33
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$241.33
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$78.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.63
|
| Rate for Payer: Blue Shield of California Commercial |
$140.96
|
| Rate for Payer: Blue Shield of California EPN |
$92.83
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.70
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
915352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
915352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$78.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.63
|
| Rate for Payer: Blue Shield of California Commercial |
$140.96
|
| Rate for Payer: Blue Shield of California EPN |
$92.83
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.70
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
OP
|
$25.58
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cigna of CA HMO |
$16.37
|
| Rate for Payer: Cigna of CA PPO |
$18.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.91
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.79
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
IP
|
$25.58
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
OP
|
$8,954.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,790.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cigna of CA HMO |
$5,730.56
|
| Rate for Payer: Cigna of CA PPO |
$6,625.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$7,610.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,372.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,148.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$7,163.20
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$5,820.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,610.90
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,372.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,477.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,477.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
IP
|
$8,954.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,790.80 |
| Max. Negotiated Rate |
$7,610.90 |
| Rate for Payer: Adventist Health Commercial |
$1,790.80
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,581.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,581.60
|
| Rate for Payer: Galaxy Health WC |
$7,610.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,372.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,411.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,542.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,148.96
|
| Rate for Payer: Multiplan Commercial |
$7,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,820.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,610.90
|
|
