|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.83
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.62
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Cigna of CA HMO |
$114.24
|
| Rate for Payer: Cigna of CA PPO |
$132.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.95
|
| Rate for Payer: Multiplan Commercial |
$142.80
|
| Rate for Payer: Networks By Design Commercial |
$116.03
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO |
$89.25
|
| Rate for Payer: United Healthcare HMO Rider |
$89.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$142.80
|
| Rate for Payer: Networks By Design Commercial |
$116.03
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.83
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.83
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.83
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORT IMAGE
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC PORT IMAGE
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$485.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.58
|
| Rate for Payer: Blue Shield of California Commercial |
$452.88
|
| Rate for Payer: Blue Shield of California EPN |
$298.96
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
|
IP
|
$232.12
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$197.30 |
| Rate for Payer: Adventist Health Commercial |
$46.42
|
| Rate for Payer: Cash Price |
$127.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.85
|
| Rate for Payer: EPIC Health Plan Senior |
$92.85
|
| Rate for Payer: Galaxy Health WC |
$197.30
|
| Rate for Payer: Global Benefits Group Commercial |
$139.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.71
|
| Rate for Payer: Multiplan Commercial |
$185.70
|
| Rate for Payer: Networks By Design Commercial |
$150.88
|
| Rate for Payer: Prime Health Services Commercial |
$197.30
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
|
OP
|
$232.12
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$197.30 |
| Rate for Payer: Adventist Health Commercial |
$46.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.54
|
| Rate for Payer: Cash Price |
$127.67
|
| Rate for Payer: Cigna of CA HMO |
$148.56
|
| Rate for Payer: Cigna of CA PPO |
$171.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.85
|
| Rate for Payer: EPIC Health Plan Senior |
$92.85
|
| Rate for Payer: Galaxy Health WC |
$197.30
|
| Rate for Payer: Global Benefits Group Commercial |
$139.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.48
|
| Rate for Payer: Multiplan Commercial |
$185.70
|
| Rate for Payer: Networks By Design Commercial |
$150.88
|
| Rate for Payer: Prime Health Services Commercial |
$197.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.06
|
| Rate for Payer: United Healthcare All Other HMO |
$116.06
|
| Rate for Payer: United Healthcare HMO Rider |
$116.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.30
|
| Rate for Payer: Vantage Medical Group Senior |
$197.30
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$49.51
|
| Rate for Payer: Blue Shield of California EPN |
$32.71
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.56
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT MED
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
OP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.56
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Cigna of CA HMO |
$45.40
|
| Rate for Payer: Cigna of CA PPO |
$52.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Other HMO |
$35.47
|
| Rate for Payer: United Healthcare HMO Rider |
$35.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT SMALL
|
Facility
|
IP
|
$70.93
|
|
| Hospital Charge Code |
901604727
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$46.10
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
OP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.03
|
| Rate for Payer: Cash Price |
$34.95
|
| Rate for Payer: Cigna of CA HMO |
$40.67
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.48
|
| Rate for Payer: Multiplan Commercial |
$50.84
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$31.77
|
| Rate for Payer: United Healthcare HMO Rider |
$31.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.02
|
| Rate for Payer: Vantage Medical Group Senior |
$54.02
|
|
|
HC POSITIONING GEL-E DONUT X-SM
|
Facility
|
IP
|
$63.55
|
|
| Hospital Charge Code |
901698581
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Senior |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$50.84
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
IP
|
$788.49
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$670.22 |
| Rate for Payer: Adventist Health Commercial |
$157.70
|
| Rate for Payer: Cash Price |
$433.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.40
|
| Rate for Payer: EPIC Health Plan Senior |
$315.40
|
| Rate for Payer: Galaxy Health WC |
$670.22
|
| Rate for Payer: Global Benefits Group Commercial |
$473.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Multiplan Commercial |
$630.79
|
| Rate for Payer: Networks By Design Commercial |
$512.52
|
| Rate for Payer: Prime Health Services Commercial |
$670.22
|
|
|
HC POST FLUIDIZED ZFLO MED
|
Facility
|
OP
|
$788.49
|
|
| Hospital Charge Code |
901605553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$670.22 |
| Rate for Payer: Adventist Health Commercial |
$157.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$517.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$670.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.21
|
| Rate for Payer: Cash Price |
$433.67
|
| Rate for Payer: Cigna of CA HMO |
$504.63
|
| Rate for Payer: Cigna of CA PPO |
$583.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$670.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$670.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$670.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.40
|
| Rate for Payer: EPIC Health Plan Senior |
$315.40
|
| Rate for Payer: Galaxy Health WC |
$670.22
|
| Rate for Payer: Global Benefits Group Commercial |
$473.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$551.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$551.94
|
| Rate for Payer: Multiplan Commercial |
$630.79
|
| Rate for Payer: Networks By Design Commercial |
$512.52
|
| Rate for Payer: Prime Health Services Commercial |
$670.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$473.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$473.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.25
|
| Rate for Payer: United Healthcare All Other HMO |
$394.25
|
| Rate for Payer: United Healthcare HMO Rider |
$394.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$670.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$670.22
|
| Rate for Payer: Vantage Medical Group Senior |
$670.22
|
|
|
HC POST MASTECTOMY BRA
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT L8000
|
| Hospital Charge Code |
905358000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$119.70
|
| Rate for Payer: Cigna of CA PPO |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$85.50
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.18
|
| Rate for Payer: United Healthcare All Other HMO |
$62.47
|
| Rate for Payer: United Healthcare HMO Rider |
$61.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
|
