|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$733.44 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$733.44
|
| Rate for Payer: Blue Shield of California Commercial |
$324.00
|
| Rate for Payer: Blue Shield of California EPN |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SMIC/ID
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC SMIC/ID
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$29.44
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SNARE BRAUN MULTI-SNARE
|
Facility
|
OP
|
$1,283.99
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$1,091.39 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$842.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,091.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$706.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$962.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$788.50
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna of CA HMO |
$821.75
|
| Rate for Payer: Cigna of CA PPO |
$950.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,091.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,091.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,091.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$513.60
|
| Rate for Payer: Galaxy Health WC |
$1,091.39
|
| Rate for Payer: Global Benefits Group Commercial |
$770.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$794.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$898.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$898.79
|
| Rate for Payer: Multiplan Commercial |
$1,027.19
|
| Rate for Payer: Networks By Design Commercial |
$834.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$770.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$770.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$642.00
|
| Rate for Payer: United Healthcare HMO Rider |
$642.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,091.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,091.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,091.39
|
|
|
HC SNARE BRAUN MULTI-SNARE
|
Facility
|
IP
|
$1,283.99
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$1,091.39 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$513.60
|
| Rate for Payer: Galaxy Health WC |
$1,091.39
|
| Rate for Payer: Global Benefits Group Commercial |
$770.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$794.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.16
|
| Rate for Payer: Multiplan Commercial |
$1,027.19
|
| Rate for Payer: Networks By Design Commercial |
$834.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.39
|
|
|
HC SNARE EN MERIT EN2007030
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,207.85 |
| Rate for Payer: Adventist Health Commercial |
$284.20
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.04
|
| Rate for Payer: Multiplan Commercial |
$1,136.80
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
|
|
HC SNARE EN MERIT EN2007030
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,207.85 |
| Rate for Payer: Adventist Health Commercial |
$284.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$932.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.64
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Cigna of CA HMO |
$909.44
|
| Rate for Payer: Cigna of CA PPO |
$1,051.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$994.70
|
| Rate for Payer: Multiplan Commercial |
$1,136.80
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.50
|
| Rate for Payer: United Healthcare All Other HMO |
$710.50
|
| Rate for Payer: United Healthcare HMO Rider |
$710.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.85
|
|
|
HC SNARE ONE MERIT ONE2000
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$1,196.00
|
| Rate for Payer: Networks By Design Commercial |
$971.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
|
|
HC SNARE ONE MERIT ONE2000
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$980.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$822.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,121.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$918.08
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cigna of CA HMO |
$956.80
|
| Rate for Payer: Cigna of CA PPO |
$1,106.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,196.00
|
| Rate for Payer: Networks By Design Commercial |
$971.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$897.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$747.50
|
| Rate for Payer: United Healthcare All Other HMO |
$747.50
|
| Rate for Payer: United Healthcare HMO Rider |
$747.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$747.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC SNARE ONE MERIT ONE700
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,585.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,484.89
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna of CA HMO |
$1,547.52
|
| Rate for Payer: Cigna of CA PPO |
$1,789.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,209.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,209.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SNARE ONE MERIT ONE700
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
915355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$482.65
|
| Rate for Payer: Blue Shield of California EPN |
$317.84
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
915355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$482.65
|
| Rate for Payer: Blue Shield of California EPN |
$317.84
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.67
|
| Rate for Payer: Blue Shield of California Commercial |
$39.54
|
| Rate for Payer: Blue Shield of California EPN |
$26.12
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna of CA HMO |
$37.82
|
| Rate for Payer: Cigna of CA PPO |
$43.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$47.28
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$50.23 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.64
|
| Rate for Payer: EPIC Health Plan Senior |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$47.28
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$1,478.16 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$491.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,478.16
|
| Rate for Payer: Blue Shield of California Commercial |
$501.75
|
| Rate for Payer: Blue Shield of California EPN |
$331.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,327.79 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$691.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,327.79
|
| Rate for Payer: Blue Shield of California Commercial |
$704.96
|
| Rate for Payer: Blue Shield of California EPN |
$465.76
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.82
|
| Rate for Payer: EPIC Health Plan Senior |
$301.35
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,374.47 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$691.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,374.47
|
| Rate for Payer: Blue Shield of California Commercial |
$704.96
|
| Rate for Payer: Blue Shield of California EPN |
$465.76
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.89
|
| Rate for Payer: EPIC Health Plan Senior |
$282.88
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$475.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
