|
HC ROOM REHAB DOU/INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$9,096.00
|
|
| Hospital Charge Code |
902311819
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,819.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,691.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,417.00
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,638.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,638.40
|
| Rate for Payer: Galaxy Health WC |
$7,731.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,457.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,067.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,465.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,630.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.04
|
| Rate for Payer: Multiplan Commercial |
$7,276.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,731.60
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
|
IP
|
$7,883.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,576.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,576.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,503.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$3,547.35
|
| Rate for Payer: Cash Price |
$3,547.35
|
| Rate for Payer: Cash Price |
$3,547.35
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,153.20
|
| Rate for Payer: Galaxy Health WC |
$6,700.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,729.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,257.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,003.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,879.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.92
|
| Rate for Payer: Multiplan Commercial |
$6,306.40
|
| Rate for Payer: Networks By Design Commercial |
$5,123.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,700.55
|
|
|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$6,054.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,210.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,503.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,421.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,421.60
|
| Rate for Payer: Galaxy Health WC |
$5,145.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,632.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,747.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.96
|
| Rate for Payer: Multiplan Commercial |
$4,843.20
|
| Rate for Payer: Networks By Design Commercial |
$3,935.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,145.90
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$8,236.00
|
|
| Hospital Charge Code |
902300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,647.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,647.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,294.40
|
| Rate for Payer: Galaxy Health WC |
$7,000.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,941.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,493.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,098.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.64
|
| Rate for Payer: Multiplan Commercial |
$6,588.80
|
| Rate for Payer: Networks By Design Commercial |
$5,353.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,000.60
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,568.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,137.60
|
| Rate for Payer: Galaxy Health WC |
$6,667.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,706.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,988.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,855.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.56
|
| Rate for Payer: Multiplan Commercial |
$6,275.20
|
| Rate for Payer: Networks By Design Commercial |
$5,098.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,667.40
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$12,136.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,427.20 |
| Max. Negotiated Rate |
$10,315.60 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,691.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,417.00
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,094.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,623.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,512.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,912.64
|
| Rate for Payer: Multiplan Commercial |
$9,708.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$10,129.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,025.80 |
| Max. Negotiated Rate |
$8,609.65 |
| Rate for Payer: Adventist Health Commercial |
$2,025.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,691.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,417.00
|
| Rate for Payer: Cash Price |
$4,558.05
|
| Rate for Payer: Cash Price |
$4,558.05
|
| Rate for Payer: Cash Price |
$4,558.05
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,051.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,051.60
|
| Rate for Payer: Galaxy Health WC |
$8,609.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,077.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,756.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,859.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,269.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,430.96
|
| Rate for Payer: Multiplan Commercial |
$8,103.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,609.65
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$27,889.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,705.65 |
| Rate for Payer: Adventist Health Commercial |
$5,577.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$12,550.05
|
| Rate for Payer: Cash Price |
$12,550.05
|
| Rate for Payer: Cash Price |
$12,550.05
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,155.60
|
| Rate for Payer: Galaxy Health WC |
$23,705.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,733.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,601.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,625.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,263.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,693.36
|
| Rate for Payer: Multiplan Commercial |
$22,311.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,705.65
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$27,077.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,015.45 |
| Rate for Payer: Adventist Health Commercial |
$5,415.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$12,184.65
|
| Rate for Payer: Cash Price |
$12,184.65
|
| Rate for Payer: Cash Price |
$12,184.65
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,830.80
|
| Rate for Payer: Galaxy Health WC |
$23,015.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,246.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,060.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,316.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,760.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,498.48
|
| Rate for Payer: Multiplan Commercial |
$21,661.60
|
| Rate for Payer: Prime Health Services Commercial |
$23,015.45
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$26,391.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,432.35 |
| Rate for Payer: Adventist Health Commercial |
$5,278.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,556.40
|
| Rate for Payer: Galaxy Health WC |
$22,432.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,834.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,602.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,054.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,336.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,333.84
|
| Rate for Payer: Multiplan Commercial |
$21,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,432.35
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,623.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,779.55 |
| Rate for Payer: Adventist Health Commercial |
$5,124.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,249.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,249.20
|
| Rate for Payer: Galaxy Health WC |
$21,779.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15,373.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,762.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,860.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,149.52
|
| Rate for Payer: Multiplan Commercial |
$20,498.40
|
| Rate for Payer: Prime Health Services Commercial |
$21,779.55
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.24
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,870.85 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,274.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.69
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.54
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$869.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$862.20
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$869.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$982.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$702.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$26.09
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.26
|
| Rate for Payer: Blue Shield of California Commercial |
$295.94
|
| Rate for Payer: Blue Shield of California EPN |
$194.89
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.26
|
| Rate for Payer: Blue Shield of California Commercial |
$295.94
|
| Rate for Payer: Blue Shield of California EPN |
$194.89
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$30.19 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.19
|
| Rate for Payer: Blue Shield of California Commercial |
$22.08
|
| Rate for Payer: Blue Shield of California EPN |
$14.59
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.17
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
