|
HC STNT NUMED CMCP 3.9 LARGER
|
Facility
|
IP
|
$16,875.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$14,343.75 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,050.00
|
| Rate for Payer: Multiplan Commercial |
$13,500.00
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
|
|
HC STNT NUMED CP 3.4 COVERED UNM
|
Facility
|
IP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.00
|
| Rate for Payer: Multiplan Commercial |
$10,700.00
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
|
|
HC STNT NUMED CP 3.4 COVERED UNM
|
Facility
|
OP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$11,368.75 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,356.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,031.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,746.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,870.75
|
| Rate for Payer: Blue Shield of California EPN |
$6,500.25
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,368.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,368.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,362.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,362.50
|
| Rate for Payer: Multiplan Commercial |
$10,700.00
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,368.75
|
|
|
HC STNT NUMED CP 3.9 COVERED UNM
|
Facility
|
OP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$11,368.75 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,356.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,031.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,746.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,870.75
|
| Rate for Payer: Blue Shield of California EPN |
$6,500.25
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,368.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,368.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,362.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,362.50
|
| Rate for Payer: Multiplan Commercial |
$10,700.00
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,368.75
|
|
|
HC STNT NUMED CP 3.9 COVERED UNM
|
Facility
|
IP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.00
|
| Rate for Payer: Multiplan Commercial |
$10,700.00
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,335.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,667.00 |
| Max. Negotiated Rate |
$7,084.75 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,559.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,175.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,159.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,335.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,584.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,251.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna of CA HMO |
$5,334.40
|
| Rate for Payer: Cigna of CA PPO |
$6,167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,084.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,084.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,169.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,559.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,716.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,159.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,834.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,834.50
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,001.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,084.75
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,885.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,455.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,075.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Cigna of CA HMO |
$5,184.64
|
| Rate for Payer: Cigna of CA PPO |
$5,994.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,885.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,885.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,885.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,240.40
|
| Rate for Payer: Galaxy Health WC |
$6,885.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,860.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,169.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,716.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,014.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,944.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,670.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,670.70
|
| Rate for Payer: Multiplan Commercial |
$6,480.80
|
| Rate for Payer: Networks By Design Commercial |
$5,265.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,885.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,860.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,885.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,885.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,885.85
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.20 |
| Max. Negotiated Rate |
$6,885.85 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,240.40
|
| Rate for Payer: Galaxy Health WC |
$6,885.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,860.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,086.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,014.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,944.24
|
| Rate for Payer: Multiplan Commercial |
$6,480.80
|
| Rate for Payer: Networks By Design Commercial |
$5,265.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,885.85
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
OP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$8,007.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,181.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,456.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6,951.96
|
| Rate for Payer: Blue Shield of California EPN |
$4,578.12
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,007.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,007.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,589.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,830.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,594.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,594.00
|
| Rate for Payer: Multiplan Commercial |
$7,536.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,652.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,535.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3,366.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,085.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,007.00
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
IP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,589.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,830.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.80
|
| Rate for Payer: Multiplan Commercial |
$7,536.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,535.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3,366.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,085.05
|
|
|
HC STNT WALL CAROTID
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,447.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,977.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.00
|
| Rate for Payer: Multiplan Commercial |
$5,140.00
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2,347.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.19
|
|
|
HC STNT WALL CAROTID
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$5,461.25 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,533.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,741.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,122.55
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,461.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,461.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,447.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,977.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,497.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,497.50
|
| Rate for Payer: Multiplan Commercial |
$5,140.00
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2,347.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,461.25
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,506.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,126.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2,069.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,024.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,855.29
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$4,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,248.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,281.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4,180.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,753.19
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,815.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,815.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,506.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,965.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,965.50
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,126.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2,069.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,024.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,855.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,815.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,401.25 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,553.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,636.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,084.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,372.95
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,401.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,401.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,748.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,977.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,977.50
|
| Rate for Payer: Multiplan Commercial |
$2,260.00
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,695.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,695.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,031.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,009.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,401.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,748.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.00
|
| Rate for Payer: Multiplan Commercial |
$2,260.00
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,031.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,009.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.19
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
905350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
915350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.65
|
| Rate for Payer: Blue Shield of California Commercial |
$61.99
|
| Rate for Payer: Blue Shield of California EPN |
$40.82
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
915350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
905350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.65
|
| Rate for Payer: Blue Shield of California Commercial |
$61.99
|
| Rate for Payer: Blue Shield of California EPN |
$40.82
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.97
|
| Rate for Payer: Blue Shield of California Commercial |
$214.02
|
| Rate for Payer: Blue Shield of California EPN |
$140.94
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
915352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
915352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.97
|
| Rate for Payer: Blue Shield of California Commercial |
$214.02
|
| Rate for Payer: Blue Shield of California EPN |
$140.94
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
