|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$39.45
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: InnovAge PACE Commercial |
$25.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
IP
|
$6,912.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,382.40 |
| Max. Negotiated Rate |
$6,220.80 |
| Rate for Payer: Adventist Health Commercial |
$1,382.40
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,529.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.80
|
| Rate for Payer: Galaxy Health WC |
$5,875.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,610.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,278.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Multiplan Commercial |
$5,184.00
|
| Rate for Payer: Networks By Design Commercial |
$4,492.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,875.20
|
|
|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
OP
|
$6,912.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,220.80 |
| Rate for Payer: Adventist Health Commercial |
$2,833.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,529.60
|
| Rate for Payer: Cigna of CA HMO |
$4,423.68
|
| Rate for Payer: Cigna of CA PPO |
$5,114.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$5,875.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,220.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,610.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$5,184.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,492.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,875.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,147.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,147.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$31.69
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.61
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California Commercial |
$31.69
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$31.69
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.61
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California Commercial |
$31.69
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Blue Shield of California Commercial |
$140.69
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.89
|
| Rate for Payer: Blue Shield of California Commercial |
$140.69
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.20
|
| Rate for Payer: InnovAge PACE Commercial |
$91.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Blue Shield of California Commercial |
$140.69
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.89
|
| Rate for Payer: Blue Shield of California Commercial |
$140.69
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.20
|
| Rate for Payer: InnovAge PACE Commercial |
$91.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Senior |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: InnovAge PACE Commercial |
$57.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC MFN DRUG ADD-ON, PER DOSE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT M1145
|
| Hospital Charge Code |
901700053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$183.30
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC MFN DRUG ADD-ON, PER DOSE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT M1145
|
| Hospital Charge Code |
901700053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC MIAMI J REPLCMNT PAD SHORT
|
Facility
|
IP
|
$135.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$121.75 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Blue Shield of California Commercial |
$104.57
|
| Rate for Payer: Blue Shield of California EPN |
$68.18
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Central Health Plan Commercial |
$108.22
|
| Rate for Payer: Cigna of CA HMO |
$94.70
|
| Rate for Payer: Cigna of CA PPO |
$94.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Senior |
$54.11
|
| Rate for Payer: Galaxy Health WC |
$114.99
|
| Rate for Payer: Global Benefits Group Commercial |
$81.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$101.46
|
| Rate for Payer: Networks By Design Commercial |
$87.93
|
| Rate for Payer: Prime Health Services Commercial |
$114.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$49.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.30
|
|
|
HC MIAMI J REPLCMNT PAD SHORT
|
Facility
|
OP
|
$135.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$121.75 |
| Rate for Payer: Adventist Health Commercial |
$55.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.45
|
| Rate for Payer: Blue Shield of California Commercial |
$104.57
|
| Rate for Payer: Blue Shield of California EPN |
$68.18
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Central Health Plan Commercial |
$108.22
|
| Rate for Payer: Cigna of CA HMO |
$94.70
|
| Rate for Payer: Cigna of CA PPO |
$94.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Senior |
$54.11
|
| Rate for Payer: Galaxy Health WC |
$114.99
|
| Rate for Payer: Global Benefits Group Commercial |
$81.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.75
|
| Rate for Payer: InnovAge PACE Commercial |
$67.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.70
|
| Rate for Payer: Multiplan Commercial |
$101.46
|
| Rate for Payer: Networks By Design Commercial |
$67.64
|
| Rate for Payer: Prime Health Services Commercial |
$114.99
|
| Rate for Payer: Riverside University Health System MISP |
$54.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$49.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.99
|
| Rate for Payer: Vantage Medical Group Senior |
$114.99
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
IP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$22.06
|
| Rate for Payer: Blue Shield of California Commercial |
$85.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.06
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$71.68
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
OP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$45.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.77
|
| Rate for Payer: Blue Shield of California Commercial |
$85.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: InnovAge PACE Commercial |
$55.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.20
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$55.14
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: Riverside University Health System MISP |
$44.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.74
|
| Rate for Payer: Vantage Medical Group Senior |
$93.74
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
IP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$22.06
|
| Rate for Payer: Blue Shield of California Commercial |
$85.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.06
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$71.68
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
OP
|
$110.28
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Adventist Health Commercial |
$45.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.77
|
| Rate for Payer: Blue Shield of California Commercial |
$85.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Central Health Plan Commercial |
$88.22
|
| Rate for Payer: Cigna of CA HMO |
$77.20
|
| Rate for Payer: Cigna of CA PPO |
$77.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.11
|
| Rate for Payer: EPIC Health Plan Senior |
$44.11
|
| Rate for Payer: Galaxy Health WC |
$93.74
|
| Rate for Payer: Global Benefits Group Commercial |
$66.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.25
|
| Rate for Payer: InnovAge PACE Commercial |
$55.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.20
|
| Rate for Payer: Multiplan Commercial |
$82.71
|
| Rate for Payer: Networks By Design Commercial |
$55.14
|
| Rate for Payer: Prime Health Services Commercial |
$93.74
|
| Rate for Payer: Riverside University Health System MISP |
$44.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.39
|
| Rate for Payer: United Healthcare All Other HMO |
$40.29
|
| Rate for Payer: United Healthcare HMO Rider |
$39.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.74
|
| Rate for Payer: Vantage Medical Group Senior |
$93.74
|
|
|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
OP
|
$235.06
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.98 |
| Max. Negotiated Rate |
$211.55 |
| Rate for Payer: Adventist Health Commercial |
$96.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.05
|
| Rate for Payer: Blue Shield of California Commercial |
$181.70
|
| Rate for Payer: Blue Shield of California EPN |
$118.47
|
| Rate for Payer: Cash Price |
$129.28
|
| Rate for Payer: Central Health Plan Commercial |
$188.05
|
| Rate for Payer: Cigna of CA HMO |
$164.54
|
| Rate for Payer: Cigna of CA PPO |
$164.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.02
|
| Rate for Payer: EPIC Health Plan Senior |
$94.02
|
| Rate for Payer: Galaxy Health WC |
$199.80
|
| Rate for Payer: Global Benefits Group Commercial |
$141.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.55
|
| Rate for Payer: InnovAge PACE Commercial |
$117.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.54
|
| Rate for Payer: Multiplan Commercial |
$176.29
|
| Rate for Payer: Networks By Design Commercial |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$199.80
|
| Rate for Payer: Riverside University Health System MISP |
$94.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.22
|
| Rate for Payer: United Healthcare All Other HMO |
$85.87
|
| Rate for Payer: United Healthcare HMO Rider |
$84.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.80
|
| Rate for Payer: Vantage Medical Group Senior |
$199.80
|
|
|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
IP
|
$235.06
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$211.55 |
| Rate for Payer: Adventist Health Commercial |
$47.01
|
| Rate for Payer: Blue Shield of California Commercial |
$181.70
|
| Rate for Payer: Blue Shield of California EPN |
$118.47
|
| Rate for Payer: Cash Price |
$129.28
|
| Rate for Payer: Central Health Plan Commercial |
$188.05
|
| Rate for Payer: Cigna of CA HMO |
$164.54
|
| Rate for Payer: Cigna of CA PPO |
$164.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.02
|
| Rate for Payer: EPIC Health Plan Senior |
$94.02
|
| Rate for Payer: Galaxy Health WC |
$199.80
|
| Rate for Payer: Global Benefits Group Commercial |
$141.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$176.29
|
| Rate for Payer: Networks By Design Commercial |
$152.79
|
| Rate for Payer: Prime Health Services Commercial |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.22
|
| Rate for Payer: United Healthcare All Other HMO |
$85.87
|
| Rate for Payer: United Healthcare HMO Rider |
$84.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.98
|
|
