|
HC PNEUMATIC KNEE SPLINT
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT L4380
|
| Hospital Charge Code |
905354380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Adventist Health Commercial |
$81.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.26
|
| Rate for Payer: Blue Shield of California Commercial |
$146.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.71
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$139.30
|
| Rate for Payer: Cigna of CA PPO |
$139.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$169.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.30
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$99.50
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.68
|
| Rate for Payer: United Healthcare All Other HMO |
$72.69
|
| Rate for Payer: United Healthcare HMO Rider |
$71.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.15
|
| Rate for Payer: Vantage Medical Group Senior |
$169.15
|
|
|
HC PNEUMATIC KNEE SPLINT
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT L4380
|
| Hospital Charge Code |
905354380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$39.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$139.30
|
| Rate for Payer: Cigna of CA PPO |
$139.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$99.50
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.68
|
| Rate for Payer: United Healthcare All Other HMO |
$72.69
|
| Rate for Payer: United Healthcare HMO Rider |
$71.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.35
|
| Rate for Payer: Blue Shield of California Commercial |
$399.26
|
| Rate for Payer: Blue Shield of California EPN |
$262.93
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.35
|
| Rate for Payer: Blue Shield of California Commercial |
$399.26
|
| Rate for Payer: Blue Shield of California EPN |
$262.93
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.50
|
| Rate for Payer: Blue Shield of California Commercial |
$549.81
|
| Rate for Payer: Blue Shield of California EPN |
$362.07
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| 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 |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$215.68
|
| Rate for Payer: Cigna of CA PPO |
$249.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| 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 |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$206.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| 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 |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| 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 |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC POOLING COMPONENTS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC POOLING COMPONENTS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.75
|
| Rate for Payer: Blue Shield of California Commercial |
$214.08
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
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 PORPHOBILINOGEN QUAL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$42.29 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.37
|
| Rate for Payer: Blue Shield of California EPN |
$7.51
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$815.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.32
|
| Rate for Payer: Multiplan Commercial |
$1,054.40
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.65
|
| Rate for Payer: United Healthcare All Other HMO |
$481.47
|
| Rate for Payer: United Healthcare HMO Rider |
$471.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.64
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,120.30 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$724.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$988.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$763.39
|
| Rate for Payer: Blue Shield of California Commercial |
$972.68
|
| Rate for Payer: Blue Shield of California EPN |
$640.55
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,120.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$815.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$922.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$922.60
|
| Rate for Payer: Multiplan Commercial |
$1,054.40
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.65
|
| Rate for Payer: United Healthcare All Other HMO |
$481.47
|
| Rate for Payer: United Healthcare HMO Rider |
$471.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.30
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.25
|
| 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 |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO |
$378.24
|
| Rate for Payer: Cigna of CA PPO |
$437.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.70
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| 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 |
$502.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
IP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
|
