|
HC WHO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
905353909
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.35
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC WHO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
905353909
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
915353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$1,258.00 |
| Rate for Payer: Adventist Health Commercial |
$606.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,110.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,092.24
|
| Rate for Payer: Blue Shield of California EPN |
$719.28
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,258.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,258.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$953.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,036.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,036.00
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$296.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$1,258.00 |
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
| Rate for Payer: Adventist Health Commercial |
$606.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,110.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,092.24
|
| Rate for Payer: Blue Shield of California EPN |
$719.28
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,258.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,258.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$953.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,036.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,036.00
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
915353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$296.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
OP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
915353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.81 |
| Max. Negotiated Rate |
$1,143.28 |
| Rate for Payer: Adventist Health Commercial |
$551.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$739.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.04
|
| Rate for Payer: Blue Shield of California Commercial |
$992.63
|
| Rate for Payer: Blue Shield of California EPN |
$653.68
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,143.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,143.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$532.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$941.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.52
|
| Rate for Payer: Multiplan Commercial |
$1,076.02
|
| Rate for Payer: Networks By Design Commercial |
$672.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.28
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
IP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
905353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.81
|
| Rate for Payer: Multiplan Commercial |
$1,076.02
|
| Rate for Payer: Networks By Design Commercial |
$672.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
IP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
915353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.81
|
| Rate for Payer: Multiplan Commercial |
$1,076.02
|
| Rate for Payer: Networks By Design Commercial |
$672.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
OP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
905353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.81 |
| Max. Negotiated Rate |
$1,143.28 |
| Rate for Payer: Adventist Health Commercial |
$551.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$739.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.04
|
| Rate for Payer: Blue Shield of California Commercial |
$992.63
|
| Rate for Payer: Blue Shield of California EPN |
$653.68
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,143.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,143.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$532.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$941.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.52
|
| Rate for Payer: Multiplan Commercial |
$1,076.02
|
| Rate for Payer: Networks By Design Commercial |
$672.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.28
|
|
|
HC WINDOWING OF CAST
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Adventist Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Senior |
$364.00
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Networks By Design Commercial |
$591.50
|
| Rate for Payer: Prime Health Services Commercial |
$773.50
|
|
|
HC WINDOWING OF CAST
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$182.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: Cash Price |
$500.50
|
| Rate for Payer: Cigna of CA HMO |
$582.40
|
| Rate for Payer: Cigna of CA PPO |
$673.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$591.50
|
| Rate for Payer: Prime Health Services Commercial |
$773.50
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$455.00
|
| Rate for Payer: United Healthcare All Other HMO |
$455.00
|
| Rate for Payer: United Healthcare HMO Rider |
$455.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$455.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
|
OP
|
$3.44
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
|
IP
|
$3.44
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.75
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
HC WIPE SUREPREP BARRIER FILM
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
HC WIPE SUREPREP BARRIER FILM
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
HC WIRE ABBOTT ASAHI EXTENSION
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812645
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC WIRE ABBOTT ASAHI EXTENSION
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812645
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$323.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.75
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$345.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC WIRE ABBOTT ASAHI SION
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$527.85 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$407.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.36
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO |
$397.44
|
| Rate for Payer: Cigna of CA PPO |
$459.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$527.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.40
|
| Rate for Payer: EPIC Health Plan Senior |
$248.40
|
| Rate for Payer: Galaxy Health WC |
$527.85
|
| Rate for Payer: Global Benefits Group Commercial |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.70
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Networks By Design Commercial |
$403.65
|
| Rate for Payer: Prime Health Services Commercial |
$527.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO |
$310.50
|
| Rate for Payer: United Healthcare HMO Rider |
$310.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.85
|
| Rate for Payer: Vantage Medical Group Senior |
$527.85
|
|
|
HC WIRE ABBOTT ASAHI SION
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$527.85 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.40
|
| Rate for Payer: EPIC Health Plan Senior |
$248.40
|
| Rate for Payer: Galaxy Health WC |
$527.85
|
| Rate for Payer: Global Benefits Group Commercial |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Networks By Design Commercial |
$403.65
|
| Rate for Payer: Prime Health Services Commercial |
$527.85
|
|
|
HC WIRE ABBOTT BHW
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.13
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC WIRE ABBOTT BHW
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC WIRE ABBOTTCOMMAND ES
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$905.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$847.46
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna of CA HMO |
$883.20
|
| Rate for Payer: Cigna of CA PPO |
$1,021.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,173.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$552.00
|
| Rate for Payer: Galaxy Health WC |
$1,173.00
|
| Rate for Payer: Global Benefits Group Commercial |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$897.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.00
|
|
