|
HC RED CELL SURVIVAL
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$987.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.22
|
| Rate for Payer: Blue Shield of California Commercial |
$921.06
|
| Rate for Payer: Blue Shield of California EPN |
$608.02
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: Cigna of CA HMO |
$963.20
|
| Rate for Payer: Cigna of CA PPO |
$1,113.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC RED CELL SURV - SEQ
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
|
|
HC RED CELL SURV - SEQ
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$987.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$827.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,128.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.22
|
| Rate for Payer: Blue Shield of California Commercial |
$921.06
|
| Rate for Payer: Blue Shield of California EPN |
$608.02
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: Cigna of CA HMO |
$963.20
|
| Rate for Payer: Cigna of CA PPO |
$1,113.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,279.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,279.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,053.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,053.50
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.50
|
| Rate for Payer: United Healthcare All Other HMO |
$752.50
|
| Rate for Payer: United Healthcare HMO Rider |
$752.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,279.25
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$934.45
|
| Rate for Payer: Cash Price |
$934.45
|
| Rate for Payer: Cash Price |
$934.45
|
| Rate for Payer: Cigna of CA HMO |
$1,087.36
|
| Rate for Payer: Cigna of CA PPO |
$1,257.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$849.50
|
| Rate for Payer: United Healthcare All Other HMO |
$849.50
|
| Rate for Payer: United Healthcare HMO Rider |
$849.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$849.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.80 |
| Max. Negotiated Rate |
$1,444.15 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Cash Price |
$934.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,051.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.76
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.35
|
| Rate for Payer: Blue Shield of California Commercial |
$58.20
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.94 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna of CA HMO |
$1,248.00
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$975.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Senior |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.88
|
| Rate for Payer: Blue Shield of California Commercial |
$960.23
|
| Rate for Payer: Blue Shield of California EPN |
$633.88
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$971.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$481.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$329.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$481.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$329.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$454.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$454.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$540.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: Cigna of CA HMO |
$527.36
|
| Rate for Payer: Cigna of CA PPO |
$609.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$329.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$549.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$494.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$494.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$700.40 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Cash Price |
$453.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Senior |
$329.60
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$549.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$553.72
|
| Rate for Payer: Blue Shield of California Commercial |
$705.53
|
| Rate for Payer: Blue Shield of California EPN |
$464.62
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$553.72
|
| Rate for Payer: Blue Shield of California Commercial |
$705.53
|
| Rate for Payer: Blue Shield of California EPN |
$464.62
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$2,380.00
|
| Rate for Payer: Cash Price |
$6,545.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,760.00
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,937.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,533.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,366.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
|
