|
HC POUCH UROSTOMY 1 PIECE CUT FIT
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4430
|
| Hospital Charge Code |
901698463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC POUCH UROSTOMY 1 PIECE CUT FIT
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT A4430
|
| Hospital Charge Code |
901698463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.16
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
|
HC POUCH UROSTOMY FLEX MAXI RED
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
CPT A5073
|
| Hospital Charge Code |
901698598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
HC POUCH UROSTOMY FLEX MAXI RED
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
CPT A5073
|
| Hospital Charge Code |
901698598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.21
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
OP
|
$125.40
|
|
| Hospital Charge Code |
901605216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$106.59 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.01
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$80.26
|
| Rate for Payer: Cigna of CA PPO |
$92.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Senior |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.78
|
| Rate for Payer: Multiplan Commercial |
$100.32
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.70
|
| Rate for Payer: United Healthcare All Other HMO |
$62.70
|
| Rate for Payer: United Healthcare HMO Rider |
$62.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.59
|
| Rate for Payer: Vantage Medical Group Senior |
$106.59
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
IP
|
$502.16
|
|
| Hospital Charge Code |
901692014
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.43 |
| Max. Negotiated Rate |
$426.84 |
| Rate for Payer: Adventist Health Commercial |
$100.43
|
| Rate for Payer: Cash Price |
$225.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.86
|
| Rate for Payer: EPIC Health Plan Senior |
$200.86
|
| Rate for Payer: Galaxy Health WC |
$426.84
|
| Rate for Payer: Global Benefits Group Commercial |
$301.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$401.73
|
| Rate for Payer: Networks By Design Commercial |
$326.40
|
| Rate for Payer: Prime Health Services Commercial |
$426.84
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
OP
|
$502.16
|
|
| Hospital Charge Code |
901692014
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.43 |
| Max. Negotiated Rate |
$426.84 |
| Rate for Payer: Adventist Health Commercial |
$100.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$426.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.38
|
| Rate for Payer: Cash Price |
$225.97
|
| Rate for Payer: Cigna of CA HMO |
$321.38
|
| Rate for Payer: Cigna of CA PPO |
$371.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$426.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$426.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$426.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.86
|
| Rate for Payer: EPIC Health Plan Senior |
$200.86
|
| Rate for Payer: Galaxy Health WC |
$426.84
|
| Rate for Payer: Global Benefits Group Commercial |
$301.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.51
|
| Rate for Payer: Multiplan Commercial |
$401.73
|
| Rate for Payer: Networks By Design Commercial |
$326.40
|
| Rate for Payer: Prime Health Services Commercial |
$426.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.08
|
| Rate for Payer: United Healthcare All Other HMO |
$251.08
|
| Rate for Payer: United Healthcare HMO Rider |
$251.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$426.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$426.84
|
| Rate for Payer: Vantage Medical Group Senior |
$426.84
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
IP
|
$125.40
|
|
| Hospital Charge Code |
901605216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$106.59 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Senior |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$100.32
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
|
|
HC POUCH WOUND FISTULA 6/9X4.3
|
Facility
|
OP
|
$110.43
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.09 |
| Max. Negotiated Rate |
$93.87 |
| Rate for Payer: Adventist Health Commercial |
$22.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.82
|
| Rate for Payer: Cash Price |
$49.69
|
| Rate for Payer: Cigna of CA HMO |
$70.68
|
| Rate for Payer: Cigna of CA PPO |
$81.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.17
|
| Rate for Payer: EPIC Health Plan Senior |
$44.17
|
| Rate for Payer: Galaxy Health WC |
$93.87
|
| Rate for Payer: Global Benefits Group Commercial |
$66.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.30
|
| Rate for Payer: Multiplan Commercial |
$88.34
|
| Rate for Payer: Networks By Design Commercial |
$71.78
|
| Rate for Payer: Prime Health Services Commercial |
$93.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.22
|
| Rate for Payer: United Healthcare All Other HMO |
$55.22
|
| Rate for Payer: United Healthcare HMO Rider |
$55.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.87
|
| Rate for Payer: Vantage Medical Group Senior |
$93.87
|
|
|
HC POUCH WOUND FISTULA 6/9X4.3
|
Facility
|
IP
|
$110.43
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.09 |
| Max. Negotiated Rate |
$93.87 |
| Rate for Payer: Adventist Health Commercial |
$22.09
|
| Rate for Payer: Cash Price |
$49.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.17
|
| Rate for Payer: EPIC Health Plan Senior |
$44.17
|
| Rate for Payer: Galaxy Health WC |
$93.87
|
| Rate for Payer: Global Benefits Group Commercial |
$66.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$88.34
|
| Rate for Payer: Networks By Design Commercial |
$71.78
|
| Rate for Payer: Prime Health Services Commercial |
$93.87
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Blue Shield of California Commercial |
$166.79
|
| Rate for Payer: Blue Shield of California EPN |
$109.84
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.79
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$113.00
|
| Rate for Payer: United Healthcare HMO Rider |
$113.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.10
|
| Rate for Payer: Vantage Medical Group Senior |
$192.10
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
906820268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,327.70 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
906820268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cigna of CA HMO |
$999.68
|
| Rate for Payer: Cigna of CA PPO |
$1,155.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.05 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
906820269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.05 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cigna of CA HMO |
$999.68
|
| Rate for Payer: Cigna of CA PPO |
$1,155.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
906820269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,327.70 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.88
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
|
|
HC PREFAB HAND FINGER ORTHOSIS
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
905353911
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC PREFAB HAND FINGER ORTHOSIS
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
905353911
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$204.85 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$161.23
|
| Rate for Payer: Blue Shield of California EPN |
$106.52
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO |
$154.24
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Senior |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.61
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$204.85 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$7,530.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,506.00 |
| Max. Negotiated Rate |
$6,400.50 |
| Rate for Payer: Adventist Health Commercial |
$1,506.00
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,012.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,012.00
|
| Rate for Payer: Galaxy Health WC |
$6,400.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,661.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,807.20
|
| Rate for Payer: Multiplan Commercial |
$6,024.00
|
| Rate for Payer: Networks By Design Commercial |
$4,894.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,400.50
|
|
