|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$395.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$632.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$530.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$723.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$819.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$819.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$819.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.80
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$819.40
|
| Rate for Payer: Vantage Medical Group Senior |
$819.40
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: Adventist Health Commercial |
$394.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$631.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.10
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.55
|
| Rate for Payer: Vantage Medical Group Senior |
$818.55
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
OP
|
$717.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.34 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$143.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cigna of CA HMO |
$458.88
|
| Rate for Payer: Cigna of CA PPO |
$530.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$573.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.50
|
| Rate for Payer: United Healthcare All Other HMO |
$358.50
|
| Rate for Payer: United Healthcare HMO Rider |
$358.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$717.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$609.45 |
| Rate for Payer: Adventist Health Commercial |
$143.40
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$286.80
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$443.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.08
|
| Rate for Payer: Multiplan Commercial |
$573.60
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
908603273
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
912197004
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
912197004
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$272.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA HMO |
$425.60
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$465.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$465.50
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
908603273
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$272.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA HMO |
$425.60
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$465.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$465.50
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OUTBACK CATHETER
|
Facility
|
OP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,313.75 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,791.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,806.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,939.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3,745.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,466.45
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,313.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,313.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,141.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,552.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,552.50
|
| Rate for Payer: Multiplan Commercial |
$4,060.00
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,045.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,045.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,313.75
|
|
|
HC OUTBACK CATHETER
|
Facility
|
IP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,141.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.00
|
| Rate for Payer: Multiplan Commercial |
$4,060.00
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
|
|
HC OUTBACK ELITE RE-ENTRY CATH
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
906812724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
|
|
HC OUTBACK ELITE RE-ENTRY CATH
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
906812724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,672.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,241.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,056.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.46
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: Cigna of CA HMO |
$2,608.00
|
| Rate for Payer: Cigna of CA PPO |
$3,015.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,463.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,852.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,852.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,037.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,037.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,037.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,037.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,463.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.92
|
| Rate for Payer: Blue Shield of California Commercial |
$73.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.92
|
| Rate for Payer: Blue Shield of California Commercial |
$73.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$87.44 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.44
|
| Rate for Payer: Blue Shield of California Commercial |
$63.55
|
| Rate for Payer: Blue Shield of California EPN |
$41.99
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Senior |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.42
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
