|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$196.35 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.82
|
| Rate for Payer: Blue Shield of California Commercial |
$177.64
|
| Rate for Payer: Blue Shield of California Commercial |
$117.12
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$196.35 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.82
|
| Rate for Payer: Blue Shield of California Commercial |
$177.64
|
| Rate for Payer: Blue Shield of California Commercial |
$117.12
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.03
|
| Rate for Payer: Blue Shield of California Commercial |
$346.79
|
| Rate for Payer: Blue Shield of California Commercial |
$526.00
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.03
|
| Rate for Payer: Blue Shield of California Commercial |
$346.79
|
| Rate for Payer: Blue Shield of California Commercial |
$526.00
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.95
|
| Rate for Payer: Blue Shield of California Commercial |
$109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$71.99
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.95
|
| Rate for Payer: Blue Shield of California Commercial |
$109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$71.99
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: EPIC Health Plan Senior |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$138.56 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.56
|
| Rate for Payer: Blue Shield of California Commercial |
$147.07
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$97.27
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$135.04
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$156.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
IP
|
$6,338.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,387.30 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,436.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,739.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| Rate for Payer: Multiplan Commercial |
$5,070.40
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,485.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,753.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,387.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,387.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,436.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,300.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,739.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,436.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,436.60
|
| Rate for Payer: Multiplan Commercial |
$5,070.40
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,169.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,387.30
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$4,093.81 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,291.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$815.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,093.81
|
| Rate for Payer: Blue Shield of California Commercial |
$457.63
|
| Rate for Payer: Blue Shield of California Commercial |
$693.51
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cigna of CA HMO |
$695.68
|
| Rate for Payer: Cigna of CA PPO |
$804.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$690.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$641.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.90
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$652.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$543.50
|
| Rate for Payer: United Healthcare All Other HMO |
$543.50
|
| Rate for Payer: United Healthcare HMO Rider |
$543.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$543.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.95
|
| Rate for Payer: Vantage Medical Group Senior |
$923.95
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$690.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$641.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$3,507.25 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,961.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,507.25
|
| Rate for Payer: Blue Shield of California Commercial |
$392.37
|
| Rate for Payer: Blue Shield of California Commercial |
$594.62
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$792.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$591.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$549.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$652.40
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$591.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$549.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
IP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Multiplan Commercial |
$103.36
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Adventist Health Commercial |
$25.84
|
| Rate for Payer: Cash Price |
$58.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.01
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
OP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Adventist Health Commercial |
$25.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.91
|
| Rate for Payer: Cash Price |
$58.14
|
| Rate for Payer: Cigna of CA HMO |
$82.69
|
| Rate for Payer: Cigna of CA PPO |
$95.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.44
|
| Rate for Payer: Multiplan Commercial |
$103.36
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other HMO |
$64.60
|
| Rate for Payer: United Healthcare HMO Rider |
$64.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.82
|
| Rate for Payer: Vantage Medical Group Senior |
$109.82
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$9.64
|
| Rate for Payer: Networks By Design Commercial |
$7.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.24
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.73
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$8.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$9.64
|
| Rate for Payer: Networks By Design Commercial |
$7.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6.03
|
| Rate for Payer: United Healthcare HMO Rider |
$6.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Vantage Medical Group Senior |
$10.24
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
IP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
|
