|
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 |
$43.30 |
| Max. Negotiated Rate |
$163.80 |
| 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 |
$100.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.53
|
| Rate for Payer: Blue Distinction Transplant |
$109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$136.50
|
| Rate for Payer: Blue Shield of California EPN |
$99.01
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| 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 Media |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$136.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.70
|
| 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: LLUH Dept of Risk Management WC |
$74.62
|
| 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 |
$91.00
|
| Rate for Payer: United Healthcare All Other HMO |
$91.00
|
| Rate for Payer: United Healthcare HMO Rider |
$91.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.00
|
| 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: Blue Shield of California EPN |
$97.19
|
| Rate for Payer: Cash Price |
$81.90
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$36.40
|
| 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: United Healthcare All Other Commercial |
$68.72
|
| Rate for Payer: United Healthcare All Other HMO |
$67.12
|
| Rate for Payer: United Healthcare HMO Rider |
$65.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.06
|
|
|
HC METHACHOLINE CHLORIDE PER 1MG
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
CPT J7674
|
| Hospital Charge Code |
900807674
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.65
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.09
|
|
|
HC METHACHOLINE CHLORIDE PER 1MG
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
CPT J7674
|
| Hospital Charge Code |
900807674
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Blue Distinction Transplant |
$1.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.65
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.81
|
| Rate for Payer: Dignity Health Media |
$2.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Riverside University Health System MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO |
$1.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Vantage Medical Group Senior |
$2.81
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.86
|
| 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 |
$121.27
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: Dignity Health Media |
$38.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: InnovAge PACE Commercial |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| 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 |
$10.00
|
| 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 |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| 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 |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
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: Blue Shield of California EPN |
$72.24
|
| Rate for Payer: Cash Price |
$60.88
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$27.06
|
| 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: United Healthcare All Other Commercial |
$51.08
|
| Rate for Payer: United Healthcare All Other HMO |
$49.89
|
| Rate for Payer: United Healthcare HMO Rider |
$48.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.64
|
|
|
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 |
$47.35 |
| Max. Negotiated Rate |
$121.75 |
| 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 |
$74.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.92
|
| Rate for Payer: Blue Distinction Transplant |
$81.17
|
| Rate for Payer: Blue Shield of California Commercial |
$101.46
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$60.88
|
| 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 Media |
$114.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$101.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.46
|
| 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 |
$67.64
|
| Rate for Payer: United Healthcare All Other HMO |
$67.64
|
| Rate for Payer: United Healthcare HMO Rider |
$67.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.64
|
| 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
|
OP
|
$149.26
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.18
|
| Rate for Payer: Blue Distinction Transplant |
$89.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.94
|
| Rate for Payer: Blue Shield of California EPN |
$81.20
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Central Health Plan Commercial |
$119.41
|
| Rate for Payer: Cigna of CA HMO |
$104.48
|
| Rate for Payer: Cigna of CA PPO |
$104.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.87
|
| Rate for Payer: Dignity Health Media |
$126.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.70
|
| Rate for Payer: Galaxy Health WC |
$126.87
|
| Rate for Payer: Global Benefits Group Commercial |
$89.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$111.94
|
| Rate for Payer: Networks By Design Commercial |
$74.63
|
| Rate for Payer: Prime Health Services Commercial |
$126.87
|
| Rate for Payer: Riverside University Health System MISP |
$59.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.63
|
| Rate for Payer: United Healthcare All Other HMO |
$74.63
|
| Rate for Payer: United Healthcare HMO Rider |
$74.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.87
|
| Rate for Payer: Vantage Medical Group Senior |
$126.87
|
|
|
HC MIAMI J REPLCMNT PAD STOUT
|
Facility
|
IP
|
$149.26
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605411
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Blue Shield of California EPN |
$79.70
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Central Health Plan Commercial |
$119.41
|
| Rate for Payer: Cigna of CA HMO |
$104.48
|
| Rate for Payer: Cigna of CA PPO |
$104.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.70
|
| Rate for Payer: Galaxy Health WC |
$126.87
|
| Rate for Payer: Global Benefits Group Commercial |
$89.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.85
|
| Rate for Payer: Multiplan Commercial |
$111.94
|
| Rate for Payer: Networks By Design Commercial |
$74.63
|
| Rate for Payer: Prime Health Services Commercial |
$126.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.36
|
| Rate for Payer: United Healthcare All Other HMO |
$55.05
|
| Rate for Payer: United Healthcare HMO Rider |
$53.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.26
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
OP
|
$149.26
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.18
|
| Rate for Payer: Blue Distinction Transplant |
$89.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.94
|
| Rate for Payer: Blue Shield of California EPN |
$81.20
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Central Health Plan Commercial |
$119.41
|
| Rate for Payer: Cigna of CA HMO |
$104.48
|
| Rate for Payer: Cigna of CA PPO |
$104.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.87
|
| Rate for Payer: Dignity Health Media |
$126.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.70
|
| Rate for Payer: Galaxy Health WC |
$126.87
|
| Rate for Payer: Global Benefits Group Commercial |
$89.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$111.94
|
| Rate for Payer: Networks By Design Commercial |
$74.63
|
| Rate for Payer: Prime Health Services Commercial |
$126.87
|
| Rate for Payer: Riverside University Health System MISP |
$59.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.63
|
| Rate for Payer: United Healthcare All Other HMO |
$74.63
|
| Rate for Payer: United Healthcare HMO Rider |
$74.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.87
|
| Rate for Payer: Vantage Medical Group Senior |
$126.87
|
|
|
HC MIAMI JR REPLCMNT PAD 0-6MO
|
Facility
|
IP
|
$149.26
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605412
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Blue Shield of California EPN |
$79.70
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Central Health Plan Commercial |
$119.41
|
| Rate for Payer: Cigna of CA HMO |
$104.48
|
| Rate for Payer: Cigna of CA PPO |
$104.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.70
|
| Rate for Payer: Galaxy Health WC |
$126.87
|
| Rate for Payer: Global Benefits Group Commercial |
$89.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.85
|
| Rate for Payer: Multiplan Commercial |
$111.94
|
| Rate for Payer: Networks By Design Commercial |
$74.63
|
| Rate for Payer: Prime Health Services Commercial |
$126.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.36
|
| Rate for Payer: United Healthcare All Other HMO |
$55.05
|
| Rate for Payer: United Healthcare HMO Rider |
$53.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.26
|
|
|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
OP
|
$150.25
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.59 |
| Max. Negotiated Rate |
$135.22 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Distinction Transplant |
$90.15
|
| Rate for Payer: Blue Shield of California Commercial |
$112.69
|
| Rate for Payer: Blue Shield of California EPN |
$81.74
|
| Rate for Payer: Cash Price |
$67.61
|
| Rate for Payer: Central Health Plan Commercial |
$120.20
|
| Rate for Payer: Cigna of CA HMO |
$105.18
|
| Rate for Payer: Cigna of CA PPO |
$105.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.71
|
| Rate for Payer: Dignity Health Media |
$127.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.10
|
| Rate for Payer: Galaxy Health WC |
$127.71
|
| Rate for Payer: Global Benefits Group Commercial |
$90.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$112.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$112.69
|
| Rate for Payer: Networks By Design Commercial |
$75.12
|
| Rate for Payer: Prime Health Services Commercial |
$127.71
|
| Rate for Payer: Riverside University Health System MISP |
$60.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.12
|
| Rate for Payer: United Healthcare All Other HMO |
$75.12
|
| Rate for Payer: United Healthcare HMO Rider |
$75.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.71
|
| Rate for Payer: Vantage Medical Group Senior |
$127.71
|
|
|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
IP
|
$150.25
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$135.22 |
| Rate for Payer: Blue Shield of California EPN |
$80.23
|
| Rate for Payer: Cash Price |
$67.61
|
| Rate for Payer: Central Health Plan Commercial |
$120.20
|
| Rate for Payer: Cigna of CA HMO |
$105.18
|
| Rate for Payer: Cigna of CA PPO |
$105.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.10
|
| Rate for Payer: Galaxy Health WC |
$127.71
|
| Rate for Payer: Global Benefits Group Commercial |
$90.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.05
|
| Rate for Payer: Multiplan Commercial |
$112.69
|
| Rate for Payer: Networks By Design Commercial |
$75.12
|
| Rate for Payer: Prime Health Services Commercial |
$127.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.73
|
| Rate for Payer: United Healthcare All Other HMO |
$55.41
|
| Rate for Payer: United Healthcare HMO Rider |
$54.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.58
|
|
|
HC MIAMI JR REPLCMNT PAD 6-12YR
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.35
|
| Rate for Payer: Blue Distinction Transplant |
$57.23
|
| Rate for Payer: Blue Shield of California Commercial |
$71.54
|
| Rate for Payer: Blue Shield of California EPN |
$51.89
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Media |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.11
|
| Rate for Payer: Multiplan Commercial |
$71.54
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Riverside University Health System MISP |
$38.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.69
|
| Rate for Payer: United Healthcare All Other HMO |
$47.69
|
| Rate for Payer: United Healthcare HMO Rider |
$47.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC MIAMI JR REPLCMNT PAD 6-12YR
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Blue Shield of California EPN |
$50.93
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$71.54
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.02
|
| Rate for Payer: United Healthcare All Other HMO |
$35.18
|
| Rate for Payer: United Healthcare HMO Rider |
$34.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.48
|
|
|
HC MIAMI JR REPLCMNT PAD 6MO-2YR
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605413
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.35
|
| Rate for Payer: Blue Distinction Transplant |
$57.23
|
| Rate for Payer: Blue Shield of California Commercial |
$71.54
|
| Rate for Payer: Blue Shield of California EPN |
$51.89
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Media |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.11
|
| Rate for Payer: Multiplan Commercial |
$71.54
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Riverside University Health System MISP |
$38.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.69
|
| Rate for Payer: United Healthcare All Other HMO |
$47.69
|
| Rate for Payer: United Healthcare HMO Rider |
$47.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC MIAMI JR REPLCMNT PAD 6MO-2YR
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605413
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Blue Shield of California EPN |
$50.93
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$71.54
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.02
|
| Rate for Payer: United Healthcare All Other HMO |
$35.18
|
| Rate for Payer: United Healthcare HMO Rider |
$34.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.48
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.70
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$111.49
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Media |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Riverside University Health System MISP |
$91.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: Blue Distinction Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$526.50
|
| Rate for Payer: Blue Shield of California EPN |
$381.89
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Media |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Blue Shield of California EPN |
$374.87
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$265.08
|
| Rate for Payer: United Healthcare All Other HMO |
$258.90
|
| Rate for Payer: United Healthcare HMO Rider |
$253.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.66
|
|
|
HC MICROALBUMIN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC MICROALBUMIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.38
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: InnovAge PACE Commercial |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN URINE 24 HOURS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.38
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: InnovAge PACE Commercial |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
