|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
915358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.86
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
905358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.86
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
IP
|
$3,701.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$740.20 |
| Max. Negotiated Rate |
$3,330.90 |
| Rate for Payer: Adventist Health Commercial |
$740.20
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,960.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,480.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,480.40
|
| Rate for Payer: Galaxy Health WC |
$3,145.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,220.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,330.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,468.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,410.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,290.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.20
|
| Rate for Payer: Multiplan Commercial |
$2,775.75
|
| Rate for Payer: Networks By Design Commercial |
$2,405.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,145.85
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$740.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,960.77
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,960.80
|
| Rate for Payer: Cigna of CA HMO |
$2,368.64
|
| Rate for Payer: Cigna of CA PPO |
$2,738.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$3,145.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,220.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,330.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: InnovAge PACE Commercial |
$1,845.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,468.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,649.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$2,775.75
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,405.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,145.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,304.47
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,353.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,220.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,850.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,850.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,850.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC STYLET INTUBATION 12FR
|
Facility
|
IP
|
$19.43
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: Central Health Plan Commercial |
$15.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
|
|
HC STYLET INTUBATION 12FR
|
Facility
|
OP
|
$19.43
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.75
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: Central Health Plan Commercial |
$15.54
|
| Rate for Payer: Cigna of CA HMO |
$12.44
|
| Rate for Payer: Cigna of CA PPO |
$14.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.49
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
| Rate for Payer: Riverside University Health System MISP |
$7.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO |
$9.71
|
| Rate for Payer: United Healthcare HMO Rider |
$9.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC STYLET, INTUBATION, 14FR
|
Facility
|
IP
|
$13.69
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Central Health Plan Commercial |
$10.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5.48
|
| Rate for Payer: Galaxy Health WC |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$10.27
|
| Rate for Payer: Networks By Design Commercial |
$8.90
|
| Rate for Payer: Prime Health Services Commercial |
$11.64
|
|
|
HC STYLET, INTUBATION, 14FR
|
Facility
|
OP
|
$13.69
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.04
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Central Health Plan Commercial |
$10.95
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$10.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5.48
|
| Rate for Payer: Galaxy Health WC |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.32
|
| Rate for Payer: InnovAge PACE Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$10.27
|
| Rate for Payer: Networks By Design Commercial |
$8.90
|
| Rate for Payer: Prime Health Services Commercial |
$11.64
|
| Rate for Payer: Riverside University Health System MISP |
$5.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Vantage Medical Group Senior |
$11.64
|
|
|
HC STYLET INTUBATION 2.5-4.5MM
|
Facility
|
IP
|
$23.12
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Adventist Health Commercial |
$4.62
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Central Health Plan Commercial |
$18.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.25
|
| Rate for Payer: EPIC Health Plan Senior |
$9.25
|
| Rate for Payer: Galaxy Health WC |
$19.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$17.34
|
| Rate for Payer: Networks By Design Commercial |
$15.03
|
| Rate for Payer: Prime Health Services Commercial |
$19.65
|
|
|
HC STYLET INTUBATION 2.5-4.5MM
|
Facility
|
OP
|
$23.12
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Adventist Health Commercial |
$4.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.58
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Central Health Plan Commercial |
$18.50
|
| Rate for Payer: Cigna of CA HMO |
$14.80
|
| Rate for Payer: Cigna of CA PPO |
$17.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.25
|
| Rate for Payer: EPIC Health Plan Senior |
$9.25
|
| Rate for Payer: Galaxy Health WC |
$19.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.81
|
| Rate for Payer: InnovAge PACE Commercial |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.18
|
| Rate for Payer: Multiplan Commercial |
$17.34
|
| Rate for Payer: Networks By Design Commercial |
$15.03
|
| Rate for Payer: Prime Health Services Commercial |
$19.65
|
| Rate for Payer: Riverside University Health System MISP |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.65
|
| Rate for Payer: Vantage Medical Group Senior |
$19.65
|
|
|
HC STYLET INTUBATION 5.0-7.5MM
|
Facility
|
OP
|
$22.63
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.29
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California EPN |
$9.03
|
| Rate for Payer: Cash Price |
$12.45
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Cigna of CA HMO |
$14.48
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: InnovAge PACE Commercial |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Riverside University Health System MISP |
$9.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.31
|
| Rate for Payer: United Healthcare All Other HMO |
$11.31
|
| Rate for Payer: United Healthcare HMO Rider |
$11.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
|
HC STYLET INTUBATION 5.0-7.5MM
|
Facility
|
IP
|
$22.63
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$12.45
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC STYLET INTUBATION 6FR
|
Facility
|
OP
|
$19.19
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.27
|
| Rate for Payer: Blue Shield of California Commercial |
$11.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.35
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.43
|
| Rate for Payer: Multiplan Commercial |
$14.39
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
| Rate for Payer: Riverside University Health System MISP |
$7.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.31
|
| Rate for Payer: Vantage Medical Group Senior |
$16.31
|
|
|
HC STYLET INTUBATION 6FR
|
Facility
|
IP
|
$19.19
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$14.39
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
|
|
HC STYLET INTUBATION 6FR LUBR
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.30
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC STYLET INTUBATION 6FR LUBR
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC STYLET INTUBATION 7.5-9.5MM
|
Facility
|
IP
|
$23.21
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$18.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$19.73
|
| Rate for Payer: Global Benefits Group Commercial |
$13.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$17.41
|
| Rate for Payer: Networks By Design Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Commercial |
$19.73
|
|
|
HC STYLET INTUBATION 7.5-9.5MM
|
Facility
|
OP
|
$23.21
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.63
|
| Rate for Payer: Blue Shield of California Commercial |
$14.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.26
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$18.57
|
| Rate for Payer: Cigna of CA HMO |
$14.85
|
| Rate for Payer: Cigna of CA PPO |
$17.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$19.73
|
| Rate for Payer: Global Benefits Group Commercial |
$13.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.89
|
| Rate for Payer: InnovAge PACE Commercial |
$11.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$17.41
|
| Rate for Payer: Networks By Design Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Commercial |
$19.73
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.61
|
| Rate for Payer: United Healthcare All Other HMO |
$11.61
|
| Rate for Payer: United Healthcare HMO Rider |
$11.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.73
|
| Rate for Payer: Vantage Medical Group Senior |
$19.73
|
|
|
HC STYLET SLICK INTUBATION 8FR
|
Facility
|
OP
|
$19.68
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$3.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.56
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.85
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Central Health Plan Commercial |
$15.74
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$14.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.71
|
| Rate for Payer: InnovAge PACE Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$14.76
|
| Rate for Payer: Networks By Design Commercial |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$16.73
|
| Rate for Payer: Riverside University Health System MISP |
$7.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Other HMO |
$9.84
|
| Rate for Payer: United Healthcare HMO Rider |
$9.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.73
|
| Rate for Payer: Vantage Medical Group Senior |
$16.73
|
|
|
HC STYLET SLICK INTUBATION 8FR
|
Facility
|
IP
|
$19.68
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901607537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Central Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$14.76
|
| Rate for Payer: Networks By Design Commercial |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$16.73
|
|
|
HC STYLET VASONOVA VPS
|
Facility
|
IP
|
$675.56
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.11 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Adventist Health Commercial |
$135.11
|
| Rate for Payer: Cash Price |
$371.56
|
| Rate for Payer: Central Health Plan Commercial |
$540.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.22
|
| Rate for Payer: EPIC Health Plan Senior |
$270.22
|
| Rate for Payer: Galaxy Health WC |
$574.23
|
| Rate for Payer: Global Benefits Group Commercial |
$405.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$608.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$418.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.11
|
| Rate for Payer: Multiplan Commercial |
$506.67
|
| Rate for Payer: Networks By Design Commercial |
$439.11
|
| Rate for Payer: Prime Health Services Commercial |
$574.23
|
|
|
HC STYLET VASONOVA VPS
|
Facility
|
OP
|
$675.56
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.11 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Adventist Health Commercial |
$135.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$410.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$574.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$327.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.76
|
| Rate for Payer: Blue Shield of California Commercial |
$412.77
|
| Rate for Payer: Blue Shield of California EPN |
$269.55
|
| Rate for Payer: Cash Price |
$371.56
|
| Rate for Payer: Central Health Plan Commercial |
$540.45
|
| Rate for Payer: Cigna of CA HMO |
$432.36
|
| Rate for Payer: Cigna of CA PPO |
$499.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$574.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$574.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.22
|
| Rate for Payer: EPIC Health Plan Senior |
$270.22
|
| Rate for Payer: Galaxy Health WC |
$574.23
|
| Rate for Payer: Global Benefits Group Commercial |
$405.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$608.00
|
| Rate for Payer: InnovAge PACE Commercial |
$337.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$418.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.89
|
| Rate for Payer: Multiplan Commercial |
$506.67
|
| Rate for Payer: Networks By Design Commercial |
$439.11
|
| Rate for Payer: Prime Health Services Commercial |
$574.23
|
| Rate for Payer: Riverside University Health System MISP |
$270.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.78
|
| Rate for Payer: United Healthcare All Other HMO |
$337.78
|
| Rate for Payer: United Healthcare HMO Rider |
$337.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$574.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$574.23
|
| Rate for Payer: Vantage Medical Group Senior |
$574.23
|
|
|
HC SUBC THER INFUSION EA ADD HR
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
907296370
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC SUBC THER INFUSION EA ADD HR
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
907296370
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: EPIC Health Plan Senior |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
|
|
HC SUBC THER INFUSION UP TO 1 HR
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
907296369
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$267.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$238.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: InnovAge PACE Commercial |
$401.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$267.70
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Prime Health Services Medicare |
$283.76
|
| Rate for Payer: Riverside University Health System MISP |
$294.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
