|
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 |
$814.15
|
| Rate for Payer: Blue Shield of California Commercial |
$681.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,034.33
|
| Rate for Payer: Cash Price |
$605.26
|
| Rate for Payer: Cash Price |
$605.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$532.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.57
|
| 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
|
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 |
$814.15
|
| Rate for Payer: Blue Shield of California Commercial |
$681.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,034.33
|
| Rate for Payer: Cash Price |
$605.26
|
| Rate for Payer: Cash Price |
$605.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$532.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.57
|
| 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 |
915353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$269.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$605.26
|
| Rate for Payer: Cash Price |
$605.26
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$854.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.57
|
| 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 |
$874.27
|
| 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 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 |
$409.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$577.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.90
|
| 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 |
$5,641.00 |
| 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 |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| 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 |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| 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 |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC WINDOWING OF CAST
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Adventist Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$577.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.90
|
| 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
|
456
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$373.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| 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 |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| 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: TriValley Medical Group Commercial/Senior |
$546.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
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 |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| 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 |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| 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 |
$0.31
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| 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 |
$2.21
|
| Rate for Payer: Cash Price |
$1.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| 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 |
$1.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| 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
|
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 |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| 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 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 |
$0.70
|
| 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 |
$2.16
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| 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 WIRE ABBOTT ASAHI EXTENSION
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812645
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$316.36
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$345.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$313.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.87
|
| 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 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 |
$221.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$345.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$313.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.87
|
| 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 B/S CONTROLWIRE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC WIRE B/S CONTROLWIRE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC WIRE B/S EMBOLIC FILTERWIRE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC WIRE B/S EMBOLIC FILTERWIRE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$10,476.69 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,476.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.63
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.62
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$387.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.00
|
| Rate for Payer: United Healthcare All Other HMO |
$228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$228.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC WIRE EV3 NITREX 80CM
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.38
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna of CA HMO |
$263.68
|
| Rate for Payer: Cigna of CA PPO |
$304.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$350.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$350.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$288.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$261.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$288.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$288.40
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.00
|
| Rate for Payer: United Healthcare All Other HMO |
$206.00
|
| Rate for Payer: United Healthcare HMO Rider |
$206.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$350.20
|
| Rate for Payer: Vantage Medical Group Senior |
$350.20
|
|
|
HC WIRE EV3 NITREX 80CM
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$288.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$261.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
OP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,476.05 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,184.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,763.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2,240.10
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cigna of CA HMO |
$2,039.10
|
| Rate for Payer: Cigna of CA PPO |
$2,039.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,476.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,476.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,057.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,718.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,039.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,039.10
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,747.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,747.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,476.05
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cigna of CA HMO |
$2,039.10
|
| Rate for Payer: Cigna of CA PPO |
$2,039.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,718.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.12
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.01
|
|
