|
HC SUPPORT KNEE HINGED X-LARGE
|
Facility
|
IP
|
$216.16
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
901606732
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$43.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cash Price |
$97.27
|
| Rate for Payer: Cigna of CA HMO |
$151.31
|
| Rate for Payer: Cigna of CA PPO |
$151.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.46
|
| Rate for Payer: EPIC Health Plan Senior |
$86.46
|
| Rate for Payer: Galaxy Health WC |
$183.74
|
| Rate for Payer: Global Benefits Group Commercial |
$129.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.88
|
| Rate for Payer: Multiplan Commercial |
$172.93
|
| Rate for Payer: Networks By Design Commercial |
$108.08
|
| Rate for Payer: Prime Health Services Commercial |
$183.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.12
|
| Rate for Payer: United Healthcare All Other HMO |
$78.96
|
| Rate for Payer: United Healthcare HMO Rider |
$77.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.79
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
IP
|
$179.20
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.68
|
| Rate for Payer: EPIC Health Plan Senior |
$71.68
|
| Rate for Payer: Galaxy Health WC |
$152.32
|
| Rate for Payer: Global Benefits Group Commercial |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.01
|
| Rate for Payer: Multiplan Commercial |
$143.36
|
| Rate for Payer: Networks By Design Commercial |
$89.60
|
| Rate for Payer: Prime Health Services Commercial |
$152.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.46
|
| Rate for Payer: United Healthcare HMO Rider |
$64.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.69
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
OP
|
$179.20
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$972.99 |
| Rate for Payer: Adventist Health Commercial |
$73.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.79
|
| Rate for Payer: Blue Shield of California Commercial |
$132.25
|
| Rate for Payer: Blue Shield of California EPN |
$87.09
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$125.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.68
|
| Rate for Payer: EPIC Health Plan Senior |
$71.68
|
| Rate for Payer: Galaxy Health WC |
$152.32
|
| Rate for Payer: Global Benefits Group Commercial |
$107.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$860.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.44
|
| Rate for Payer: Multiplan Commercial |
$143.36
|
| Rate for Payer: Networks By Design Commercial |
$89.60
|
| Rate for Payer: Prime Health Services Commercial |
$152.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO |
$65.46
|
| Rate for Payer: United Healthcare HMO Rider |
$64.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: Vantage Medical Group Senior |
$152.32
|
|
|
HC SUPPORT KNEE MED OPEN PATELLA
|
Facility
|
IP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$23.94
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
|
|
HC SUPPORT KNEE MED OPEN PATELLA
|
Facility
|
OP
|
$29.93
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.38
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cigna of CA HMO |
$19.16
|
| Rate for Payer: Cigna of CA PPO |
$22.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$23.94
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.96
|
| Rate for Payer: United Healthcare All Other HMO |
$14.96
|
| Rate for Payer: United Healthcare HMO Rider |
$14.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: Vantage Medical Group Senior |
$25.44
|
|
|
HC SUPPORT SACRO LUMBAR XLG
|
Facility
|
OP
|
$143.41
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901603184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$1,187.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.06
|
| Rate for Payer: Blue Shield of California Commercial |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$69.70
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.36
|
| Rate for Payer: EPIC Health Plan Senior |
$57.36
|
| Rate for Payer: Galaxy Health WC |
$121.90
|
| Rate for Payer: Global Benefits Group Commercial |
$86.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,050.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.39
|
| Rate for Payer: Multiplan Commercial |
$114.73
|
| Rate for Payer: Networks By Design Commercial |
$71.70
|
| Rate for Payer: Prime Health Services Commercial |
$121.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.82
|
| Rate for Payer: United Healthcare All Other HMO |
$52.39
|
| Rate for Payer: United Healthcare HMO Rider |
$51.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.90
|
| Rate for Payer: Vantage Medical Group Senior |
$121.90
|
|
|
HC SUPPORT SACRO LUMBAR XLG
|
Facility
|
IP
|
$143.41
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901603184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cash Price |
$64.53
|
| Rate for Payer: Cigna of CA HMO |
$100.39
|
| Rate for Payer: Cigna of CA PPO |
$100.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.36
|
| Rate for Payer: EPIC Health Plan Senior |
$57.36
|
| Rate for Payer: Galaxy Health WC |
$121.90
|
| Rate for Payer: Global Benefits Group Commercial |
$86.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.42
|
| Rate for Payer: Multiplan Commercial |
$114.73
|
| Rate for Payer: Networks By Design Commercial |
$71.70
|
| Rate for Payer: Prime Health Services Commercial |
$121.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.82
|
| Rate for Payer: United Healthcare All Other HMO |
$52.39
|
| Rate for Payer: United Healthcare HMO Rider |
$51.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.97
|
|
|
HC SUPPORT SWIMMER ADULT LG
|
Facility
|
IP
|
$38.21
|
|
| Hospital Charge Code |
901601319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$30.57
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
|
HC SUPPORT SWIMMER ADULT LG
|
Facility
|
OP
|
$38.21
|
|
| Hospital Charge Code |
901601319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.46
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cigna of CA HMO |
$24.45
|
| Rate for Payer: Cigna of CA PPO |
$28.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$30.57
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19.11
|
| Rate for Payer: United Healthcare HMO Rider |
$19.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
HC SUPPORT SWIMMER ADULT MED
|
Facility
|
IP
|
$38.21
|
|
| Hospital Charge Code |
901601318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$30.57
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
|
HC SUPPORT SWIMMER ADULT MED
|
Facility
|
OP
|
$38.21
|
|
| Hospital Charge Code |
901601318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.46
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Cigna of CA HMO |
$24.45
|
| Rate for Payer: Cigna of CA PPO |
$28.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$30.57
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.11
|
| Rate for Payer: United Healthcare All Other HMO |
$19.11
|
| Rate for Payer: United Healthcare HMO Rider |
$19.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$32.48
|
|
|
HC SUPPORT WRIST 8IN UNIV LFT
|
Facility
|
IP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.22
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
| Rate for Payer: Networks By Design Commercial |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
|
|
HC SUPPORT WRIST 8IN UNIV LFT
|
Facility
|
OP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$39.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.04
|
| Rate for Payer: Blue Shield of California Commercial |
$71.40
|
| Rate for Payer: Blue Shield of California EPN |
$47.02
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.72
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
| Rate for Payer: Networks By Design Commercial |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.24
|
| Rate for Payer: Vantage Medical Group Senior |
$82.24
|
|
|
HC SUPPORT WRIST 8IN UNIV RT
|
Facility
|
OP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698315
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$39.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.04
|
| Rate for Payer: Blue Shield of California Commercial |
$71.40
|
| Rate for Payer: Blue Shield of California EPN |
$47.02
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.72
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
| Rate for Payer: Networks By Design Commercial |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.24
|
| Rate for Payer: Vantage Medical Group Senior |
$82.24
|
|
|
HC SUPPORT WRIST 8IN UNIV RT
|
Facility
|
IP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698315
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.22
|
| Rate for Payer: Multiplan Commercial |
$77.40
|
| Rate for Payer: Networks By Design Commercial |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
|
|
HC SUREPREP BARRIER WAND 1ML
|
Facility
|
IP
|
$6.15
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
HC SUREPREP BARRIER WAND 1ML
|
Facility
|
OP
|
$6.15
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.78
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$3.94
|
| Rate for Payer: Cigna of CA PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Vantage Medical Group Senior |
$5.23
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Senior |
$213.60
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$330.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.65
|
| Rate for Payer: Blue Shield of California Commercial |
$326.81
|
| Rate for Payer: Blue Shield of California EPN |
$215.74
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna of CA HMO |
$341.76
|
| Rate for Payer: Cigna of CA PPO |
$395.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.83
|
| Rate for Payer: EPIC Health Plan Senior |
$139.13
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$139.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.43
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$320.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$320.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.00
|
| Rate for Payer: United Healthcare All Other HMO |
$267.00
|
| Rate for Payer: United Healthcare HMO Rider |
$267.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$139.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Vantage Medical Group Senior |
$139.13
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
OP
|
$2,569.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$258.43 |
| Max. Negotiated Rate |
$2,183.65 |
| Rate for Payer: Adventist Health Commercial |
$513.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,685.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,577.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,572.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,037.88
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: Cigna of CA HMO |
$1,644.16
|
| Rate for Payer: Cigna of CA PPO |
$1,901.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$2,183.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,713.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$2,055.20
|
| Rate for Payer: Networks By Design Commercial |
$1,669.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,541.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,541.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
IP
|
$2,569.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$513.80 |
| Max. Negotiated Rate |
$2,183.65 |
| Rate for Payer: Adventist Health Commercial |
$513.80
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,027.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,027.60
|
| Rate for Payer: Galaxy Health WC |
$2,183.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,713.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,590.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.56
|
| Rate for Payer: Multiplan Commercial |
$2,055.20
|
| Rate for Payer: Networks By Design Commercial |
$1,669.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.65
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
IP
|
$1,348.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$1,145.80 |
| Rate for Payer: Adventist Health Commercial |
$269.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.20
|
| Rate for Payer: EPIC Health Plan Senior |
$539.20
|
| Rate for Payer: Galaxy Health WC |
$1,145.80
|
| Rate for Payer: Global Benefits Group Commercial |
$808.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$834.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.52
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: Networks By Design Commercial |
$876.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,145.80
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
OP
|
$1,348.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$269.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,145.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,011.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.81
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna of CA HMO |
$862.72
|
| Rate for Payer: Cigna of CA PPO |
$997.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,145.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,145.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,145.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.20
|
| Rate for Payer: EPIC Health Plan Senior |
$539.20
|
| Rate for Payer: Galaxy Health WC |
$1,145.80
|
| Rate for Payer: Global Benefits Group Commercial |
$808.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$834.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$943.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$943.60
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: Networks By Design Commercial |
$876.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,145.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$808.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$674.00
|
| Rate for Payer: United Healthcare All Other HMO |
$674.00
|
| Rate for Payer: United Healthcare HMO Rider |
$674.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$674.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,145.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,145.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,145.80
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
IP
|
$11,115.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,223.00 |
| Max. Negotiated Rate |
$9,447.75 |
| Rate for Payer: Adventist Health Commercial |
$2,223.00
|
| Rate for Payer: Cash Price |
$5,001.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,446.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,446.00
|
| Rate for Payer: Galaxy Health WC |
$9,447.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,669.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,413.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,234.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,880.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,667.60
|
| Rate for Payer: Multiplan Commercial |
$8,892.00
|
| Rate for Payer: Networks By Design Commercial |
$7,224.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,447.75
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$11,115.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,223.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,223.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,447.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,113.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,825.72
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,001.75
|
| Rate for Payer: Cash Price |
$5,001.75
|
| Rate for Payer: Cigna of CA HMO |
$7,113.60
|
| Rate for Payer: Cigna of CA PPO |
$8,225.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,447.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,447.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,446.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,446.00
|
| Rate for Payer: Galaxy Health WC |
$9,447.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,669.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,413.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,234.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,880.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,667.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,780.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,780.50
|
| Rate for Payer: Multiplan Commercial |
$8,892.00
|
| Rate for Payer: Networks By Design Commercial |
$7,224.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,447.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,557.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,557.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,557.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,557.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,447.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,447.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,447.75
|
|
