|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
OP
|
$11,187.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,068.30 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,712.20
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,034.15
|
| Rate for Payer: Cash Price |
$5,034.15
|
| Rate for Payer: Cash Price |
$5,034.15
|
| Rate for Payer: Cash Price |
$5,034.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,949.60
|
| Rate for Payer: Cigna of CA PPO |
$8,278.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$9,508.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,712.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,068.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,390.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,461.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,237.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$8,390.25
|
| Rate for Payer: Networks By Design Commercial |
$7,271.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,508.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,593.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,593.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,593.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,593.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
OP
|
$11,187.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,237.40 |
| Max. Negotiated Rate |
$10,068.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,712.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,036.62
|
| Rate for Payer: Blue Shield of California EPN |
$5,470.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,034.15
|
| Rate for Payer: Cash Price |
$5,034.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,949.60
|
| Rate for Payer: Cigna of CA HMO |
$7,159.68
|
| Rate for Payer: Cigna of CA PPO |
$8,278.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$9,508.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,712.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,068.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,390.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,461.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,237.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$8,390.25
|
| Rate for Payer: Networks By Design Commercial |
$7,271.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,508.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,593.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,593.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,593.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,593.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPHETAMINES CONF & ID
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC AMPHETAMINES CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.32
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC AMPICILLIN E TEST
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.01
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC AMPICILLIN E TEST
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC AMPLATZER PLUG
|
Facility
|
OP
|
$3,120.00
|
|
| Hospital Charge Code |
909020031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,716.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,716.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,424.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,737.84
|
| Rate for Payer: Blue Distinction Transplant |
$1,872.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,340.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,697.28
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Cigna of CA HMO |
$2,184.00
|
| Rate for Payer: Cigna of CA PPO |
$2,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Dignity Health Media |
$2,652.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,808.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,340.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,092.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,248.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,560.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,652.00
|
|
|
HC AMPLATZER PLUG
|
Facility
|
IP
|
$3,120.00
|
|
| Hospital Charge Code |
909020031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Cigna of CA HMO |
$2,184.00
|
| Rate for Payer: Cigna of CA PPO |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,808.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,125.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.60
|
|
|
HC AMPLATZ MICRO SNARE
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$2,522.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$891.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$784.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$957.10
|
| Rate for Payer: Blue Distinction Transplant |
$972.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,018.98
|
| Rate for Payer: Blue Shield of California EPN |
$792.18
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.80
|
| Rate for Payer: Cigna of CA PPO |
$1,198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Media |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health System MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC AMPLATZ MICRO SNARE
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
|
|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$346.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.91
|
| Rate for Payer: Blue Distinction Transplant |
$378.00
|
| Rate for Payer: Blue Shield of California Commercial |
$472.50
|
| Rate for Payer: Blue Shield of California EPN |
$342.72
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$535.50
|
| Rate for Payer: Dignity Health Media |
$535.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$472.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Riverside University Health System MISP |
$252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$315.00
|
| Rate for Payer: United Healthcare All Other HMO |
$315.00
|
| Rate for Payer: United Healthcare HMO Rider |
$315.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Blue Shield of California EPN |
$336.42
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.89
|
| Rate for Payer: United Healthcare All Other HMO |
$232.34
|
| Rate for Payer: United Healthcare HMO Rider |
$227.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.90
|
|
|
HC AMPLATZ SNARE
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC AMPLATZ SNARE
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$2,522.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$445.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$445.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$392.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.55
|
| Rate for Payer: Blue Distinction Transplant |
$486.00
|
| Rate for Payer: Blue Shield of California Commercial |
$509.49
|
| Rate for Payer: Blue Shield of California EPN |
$396.09
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$688.50
|
| Rate for Payer: Dignity Health Media |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$607.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Riverside University Health System MISP |
$324.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$405.00
|
| Rate for Payer: United Healthcare HMO Rider |
$405.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$405.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,153.44
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Cigna of CA HMO |
$1,512.00
|
| Rate for Payer: Cigna of CA PPO |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,440.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.62
|
| Rate for Payer: United Healthcare All Other HMO |
$796.61
|
| Rate for Payer: United Healthcare HMO Rider |
$779.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$712.80
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,188.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$986.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,203.12
|
| Rate for Payer: Blue Distinction Transplant |
$1,296.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,620.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,175.04
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Cigna of CA HMO |
$1,512.00
|
| Rate for Payer: Cigna of CA PPO |
$1,512.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Dignity Health Media |
$1,836.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,620.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,440.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: Riverside University Health System MISP |
$864.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,296.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,296.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,080.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,080.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,080.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,836.00
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$602.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$735.24
|
| Rate for Payer: Blue Distinction Transplant |
$792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$990.00
|
| Rate for Payer: Blue Shield of California EPN |
$718.08
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO |
$924.00
|
| Rate for Payer: Cigna of CA PPO |
$924.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Dignity Health Media |
$1,122.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$990.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$880.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: Networks By Design Commercial |
$660.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: Riverside University Health System MISP |
$528.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.00
|
| Rate for Payer: United Healthcare All Other HMO |
$660.00
|
| Rate for Payer: United Healthcare HMO Rider |
$660.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$660.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.00
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Blue Shield of California EPN |
$704.88
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO |
$924.00
|
| Rate for Payer: Cigna of CA PPO |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$880.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.43
|
| Rate for Payer: United Healthcare All Other HMO |
$486.82
|
| Rate for Payer: United Healthcare HMO Rider |
$476.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$435.60
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.51
|
| Rate for Payer: Blue Distinction Transplant |
$175.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.67
|
| Rate for Payer: Blue Shield of California EPN |
$142.79
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Media |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$219.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Riverside University Health System MISP |
$116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$361.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$441.14
|
| Rate for Payer: Blue Distinction Transplant |
$475.20
|
| Rate for Payer: Blue Shield of California Commercial |
$594.00
|
| Rate for Payer: Blue Shield of California EPN |
$430.85
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$554.40
|
| Rate for Payer: Cigna of CA PPO |
$554.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Media |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$594.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$396.00
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Blue Shield of California EPN |
$422.93
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$554.40
|
| Rate for Payer: Cigna of CA PPO |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.06
|
| Rate for Payer: United Healthcare All Other HMO |
$292.09
|
| Rate for Payer: United Healthcare HMO Rider |
$285.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.36
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
IP
|
$11,041.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,208.20 |
| Max. Negotiated Rate |
$9,936.90 |
| Rate for Payer: Cash Price |
$4,968.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,832.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,416.40
|
| Rate for Payer: Galaxy Health WC |
$9,384.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,624.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,936.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,364.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,206.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,208.20
|
| Rate for Payer: Multiplan Commercial |
$8,280.75
|
| Rate for Payer: Networks By Design Commercial |
$7,176.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,384.85
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
OP
|
$11,041.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,936.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,624.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$4,968.45
|
| Rate for Payer: Cash Price |
$4,968.45
|
| Rate for Payer: Cash Price |
$4,968.45
|
| Rate for Payer: Cash Price |
$4,968.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,832.80
|
| Rate for Payer: Cigna of CA PPO |
$8,170.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$9,384.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,624.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,936.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,280.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,364.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,208.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$8,280.75
|
| Rate for Payer: Networks By Design Commercial |
$7,176.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,384.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,624.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,520.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,520.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,520.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,520.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
OP
|
$12,530.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$590.65 |
| Max. Negotiated Rate |
$11,277.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,518.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,881.37
|
| Rate for Payer: Blue Shield of California EPN |
$6,127.17
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,638.50
|
| Rate for Payer: Cash Price |
$5,638.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,024.00
|
| Rate for Payer: Cigna of CA PPO |
$9,272.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$10,650.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,518.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,277.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,397.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,357.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$9,397.50
|
| Rate for Payer: Networks By Design Commercial |
$8,144.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,650.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,518.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,518.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
