|
HC COOK LIBERATOR BEACON TIP STYLET
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC COOK NEEDLE EYE SNARE ONLY
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,386.80 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.92
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
|
|
HC COOK NEEDLE EYE SNARE ONLY
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,386.80 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,841.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,544.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,106.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,724.39
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Cigna of CA HMO |
$1,797.12
|
| Rate for Payer: Cigna of CA PPO |
$2,077.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,386.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,386.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,965.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,684.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,684.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,386.80
|
|
|
HC COOK NEEDLE EYE SNARE SET
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812718
|
|
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: Aetna of CA HMO/PPO |
$2,558.01
|
| 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 |
$2,394.99
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK NEEDLE EYE SNARE SET
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812718
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK ONE-TIE COMPRESSION COIL
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
906812713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$781.15 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$568.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.56
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
|
|
HC COOK ONE-TIE COMPRESSION COIL
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
906812713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$781.15 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$602.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$781.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$505.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.36
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cigna of CA HMO |
$588.16
|
| Rate for Payer: Cigna of CA PPO |
$680.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$781.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$781.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$568.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.30
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$551.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$551.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$459.50
|
| Rate for Payer: United Healthcare All Other HMO |
$459.50
|
| Rate for Payer: United Healthcare HMO Rider |
$459.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$459.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$781.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.15
|
| Rate for Payer: Vantage Medical Group Senior |
$781.15
|
|
|
HC COOK SHORTIE RL ENTRY SHEATH
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812714
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK SHORTIE RL ENTRY SHEATH
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812714
|
|
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: Aetna of CA HMO/PPO |
$2,558.01
|
| 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 |
$2,394.99
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK SOF-GRIP HEMOSTAT
|
Facility
|
IP
|
$429.00
|
|
| Hospital Charge Code |
906812709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$343.20
|
| Rate for Payer: Networks By Design Commercial |
$278.85
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
|
|
HC COOK SOF-GRIP HEMOSTAT
|
Facility
|
OP
|
$429.00
|
|
| Hospital Charge Code |
906812709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.45
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO |
$274.56
|
| Rate for Payer: Cigna of CA PPO |
$317.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$300.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$343.20
|
| Rate for Payer: Networks By Design Commercial |
$278.85
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.50
|
| Rate for Payer: United Healthcare All Other HMO |
$214.50
|
| Rate for Payer: United Healthcare HMO Rider |
$214.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC COOK STEADYSHEATH EVOLUTION RL
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC COOK STEADYSHEATH EVOLUTION RL
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,008.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$652.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$890.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$728.94
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,008.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,008.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$830.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$830.90
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$593.50
|
| Rate for Payer: United Healthcare All Other HMO |
$593.50
|
| Rate for Payer: United Healthcare HMO Rider |
$593.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$593.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,008.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,008.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.95
|
|
|
HC COOK STEADYSHEATH SHORTIE RL
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$699.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$906.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$586.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$800.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$655.24
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$906.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$906.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$906.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$746.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$746.90
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.50
|
| Rate for Payer: United Healthcare All Other HMO |
$533.50
|
| Rate for Payer: United Healthcare HMO Rider |
$533.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$906.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$906.95
|
| Rate for Payer: Vantage Medical Group Senior |
$906.95
|
|
|
HC COOK STEADYSHEATH SHORTIE RL
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC COOMBS TEST DIRECT
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$169.26
|
| Rate for Payer: Blue Shield of California EPN |
$111.83
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC COOMBS TEST DIRECT
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$461.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$461.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
IP
|
$5,133.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$4,363.05 |
| Rate for Payer: Adventist Health Commercial |
$1,026.60
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.20
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,955.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.92
|
| Rate for Payer: Multiplan Commercial |
$4,106.40
|
| Rate for Payer: Networks By Design Commercial |
$3,336.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
OP
|
$5,133.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: Adventist Health Commercial |
$1,026.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cash Price |
$2,309.85
|
| Rate for Payer: Cigna of CA HMO |
$3,285.12
|
| Rate for Payer: Cigna of CA PPO |
$3,798.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,363.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,476.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,423.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,669.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,106.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,336.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.05
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
