|
HC RESUSCITATOR PEDS SIZE 1 & 2
|
Facility
|
OP
|
$231.70
|
|
| Hospital Charge Code |
901698718
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$196.94 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.29
|
| Rate for Payer: Cash Price |
$127.44
|
| Rate for Payer: Cigna of CA HMO |
$148.29
|
| Rate for Payer: Cigna of CA PPO |
$171.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.19
|
| Rate for Payer: Multiplan Commercial |
$185.36
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.85
|
| Rate for Payer: United Healthcare All Other HMO |
$115.85
|
| Rate for Payer: United Healthcare HMO Rider |
$115.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.94
|
| Rate for Payer: Vantage Medical Group Senior |
$196.94
|
|
|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.93
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$45.97
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.49
|
| Rate for Payer: Blue Shield of California Commercial |
$82.96
|
| Rate for Payer: Blue Shield of California EPN |
$54.81
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
OP
|
$5,964.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.57 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cigna of CA HMO |
$3,816.96
|
| Rate for Payer: Cigna of CA PPO |
$4,413.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$941.02
|
| Rate for Payer: EPIC Health Plan Senior |
$697.05
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,143.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$441.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$697.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,977.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$878.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$934.05
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
| Rate for Payer: Prime Health Services WC |
$1,099.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,578.40
|
| 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: Upland Medical Group Pediatric |
$697.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.75
|
| Rate for Payer: Vantage Medical Group Senior |
$697.05
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
IP
|
$5,964.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,385.60
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,977.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,691.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$611.15 |
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Cash Price |
$395.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$395.45
|
| Rate for Payer: Cash Price |
$395.45
|
| Rate for Payer: Cash Price |
$395.45
|
| Rate for Payer: Cigna of CA HMO |
$460.16
|
| Rate for Payer: Cigna of CA PPO |
$532.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$431.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$359.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,866.62
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: Cigna of CA HMO |
$2,987.52
|
| Rate for Payer: Cigna of CA PPO |
$3,454.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,113.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,800.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$3,967.80 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,867.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,867.20
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,113.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,778.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,889.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,866.62
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: Cigna of CA HMO |
$2,987.52
|
| Rate for Payer: Cigna of CA PPO |
$3,454.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,113.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,800.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$3,967.80 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Cash Price |
$2,567.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,867.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,867.20
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,113.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,778.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,889.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Cash Price |
$662.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$481.60
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$458.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$745.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$789.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.62
|
| Rate for Payer: Blue Shield of California Commercial |
$736.85
|
| Rate for Payer: Blue Shield of California EPN |
$486.42
|
| Rate for Payer: Cash Price |
$662.20
|
| Rate for Payer: Cash Price |
$662.20
|
| Rate for Payer: Cigna of CA HMO |
$770.56
|
| Rate for Payer: Cigna of CA PPO |
$890.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.27
|
| Rate for Payer: Blue Shield of California Commercial |
$622.40
|
| Rate for Payer: Blue Shield of California EPN |
$410.87
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$629.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$92.97 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.35
|
| Rate for Payer: Blue Shield of California Commercial |
$80.72
|
| Rate for Payer: Blue Shield of California EPN |
$53.16
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$92.97 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.35
|
| Rate for Payer: Blue Shield of California Commercial |
$80.72
|
| Rate for Payer: Blue Shield of California EPN |
$53.16
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REVERSE MVP MICRO VASC PLUG
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
906812754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,602.30 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Cash Price |
$2,330.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.12
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
|
|
HC REVERSE MVP MICRO VASC PLUG
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
906812754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,602.30 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,779.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,330.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,178.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,602.56
|
| Rate for Payer: Cash Price |
$2,330.90
|
| Rate for Payer: Cigna of CA HMO |
$2,712.32
|
| Rate for Payer: Cigna of CA PPO |
$3,136.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,602.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,602.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,966.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,966.60
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,542.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,542.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,602.30
|
|
