|
HC INDR COOK KELLER-TIMMERMAN
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$1,314.10 |
| Rate for Payer: Adventist Health Commercial |
$309.20
|
| Rate for Payer: Cash Price |
$850.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$618.40
|
| Rate for Payer: Galaxy Health WC |
$1,314.10
|
| Rate for Payer: Global Benefits Group Commercial |
$927.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.04
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: Networks By Design Commercial |
$1,004.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
|
|
HC INDR COOK MICROPUNCTURE STIFF
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC INDR COOK MICROPUNCTURE STIFF
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.14
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
OP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$314.29 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.06
|
| Rate for Payer: Cash Price |
$203.36
|
| Rate for Payer: Cigna of CA HMO |
$236.64
|
| Rate for Payer: Cigna of CA PPO |
$273.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$258.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$258.82
|
| Rate for Payer: Multiplan Commercial |
$295.80
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.88
|
| Rate for Payer: United Healthcare All Other HMO |
$184.88
|
| Rate for Payer: United Healthcare HMO Rider |
$184.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.29
|
| Rate for Payer: Vantage Medical Group Senior |
$314.29
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
IP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$314.29 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Cash Price |
$203.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.74
|
| Rate for Payer: Multiplan Commercial |
$295.80
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
|
|
HC INDR COOK PERFORMER
|
Facility
|
OP
|
$596.85
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$507.32 |
| Rate for Payer: Adventist Health Commercial |
$119.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$391.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$507.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$447.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.53
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: Cigna of CA HMO |
$381.98
|
| Rate for Payer: Cigna of CA PPO |
$441.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.74
|
| Rate for Payer: EPIC Health Plan Senior |
$238.74
|
| Rate for Payer: Galaxy Health WC |
$507.32
|
| Rate for Payer: Global Benefits Group Commercial |
$358.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$417.80
|
| Rate for Payer: Multiplan Commercial |
$477.48
|
| Rate for Payer: Networks By Design Commercial |
$387.95
|
| Rate for Payer: Prime Health Services Commercial |
$507.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.43
|
| Rate for Payer: United Healthcare All Other HMO |
$298.43
|
| Rate for Payer: United Healthcare HMO Rider |
$298.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.32
|
| Rate for Payer: Vantage Medical Group Senior |
$507.32
|
|
|
HC INDR COOK PERFORMER
|
Facility
|
IP
|
$596.85
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$507.32 |
| Rate for Payer: Adventist Health Commercial |
$119.37
|
| Rate for Payer: Cash Price |
$328.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.74
|
| Rate for Payer: EPIC Health Plan Senior |
$238.74
|
| Rate for Payer: Galaxy Health WC |
$507.32
|
| Rate for Payer: Global Benefits Group Commercial |
$358.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.24
|
| Rate for Payer: Multiplan Commercial |
$477.48
|
| Rate for Payer: Networks By Design Commercial |
$387.95
|
| Rate for Payer: Prime Health Services Commercial |
$507.32
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR CORDIS VISTA BRITE TIP
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR CORDIS VISTA BRITE TIP
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR GORE DRYSEAL
|
Facility
|
OP
|
$4,062.50
|
|
| Hospital Charge Code |
906812454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.50 |
| Max. Negotiated Rate |
$3,453.12 |
| Rate for Payer: Adventist Health Commercial |
$812.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,664.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,453.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,234.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,046.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,494.78
|
| Rate for Payer: Cash Price |
$2,234.38
|
| Rate for Payer: Cigna of CA HMO |
$2,600.00
|
| Rate for Payer: Cigna of CA PPO |
$3,006.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,453.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,453.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,453.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,625.00
|
| Rate for Payer: Galaxy Health WC |
$3,453.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,843.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,843.75
|
| Rate for Payer: Multiplan Commercial |
$3,250.00
|
| Rate for Payer: Networks By Design Commercial |
$2,640.62
|
| Rate for Payer: Prime Health Services Commercial |
$3,453.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,437.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,031.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2,031.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,031.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,031.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,453.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,453.12
|
| Rate for Payer: Vantage Medical Group Senior |
$3,453.12
|
|
|
HC INDR GORE DRYSEAL
|
Facility
|
IP
|
$4,062.50
|
|
| Hospital Charge Code |
906812454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.50 |
| Max. Negotiated Rate |
$3,453.12 |
| Rate for Payer: Adventist Health Commercial |
$812.50
|
| Rate for Payer: Cash Price |
$2,234.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,625.00
|
| Rate for Payer: Galaxy Health WC |
$3,453.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,250.00
|
| Rate for Payer: Networks By Design Commercial |
$2,640.62
|
| Rate for Payer: Prime Health Services Commercial |
$3,453.12
|
|
|
HC INDR MED FLEXCATH STEERABLE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1766
|
| Hospital Charge Code |
906812545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| 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 |
$1,950.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| 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 INDR MED FLEXCATH STEERABLE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1766
|
| Hospital Charge Code |
906812545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$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 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 |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC INDR MED MICRA MI1255A
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,534.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.99
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna of CA HMO |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$1,731.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,521.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,170.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,170.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC INDR MED MICRA MI1255A
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,521.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
|
|
HC INDR MERIT CLASSIC SHEATH 13CM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC INDR MERIT CLASSIC SHEATH 13CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC INDR MERIT CLASSIC SHEATH 25CM
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$394.40 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$304.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.94
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$394.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$394.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.80
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.00
|
| Rate for Payer: United Healthcare All Other HMO |
$232.00
|
| Rate for Payer: United Healthcare HMO Rider |
$232.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$394.40
|
| Rate for Payer: Vantage Medical Group Senior |
$394.40
|
|
|
HC INDR MERIT CLASSIC SHEATH 25CM
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$394.40 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.36
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
|
|
HC INDR MERIT PRELUDE SNAP 13CM
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.04
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Cigna of CA HMO |
$210.56
|
| Rate for Payer: Cigna of CA PPO |
$243.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$279.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$279.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$279.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$230.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.30
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.50
|
| Rate for Payer: United Healthcare All Other HMO |
$164.50
|
| Rate for Payer: United Healthcare HMO Rider |
$164.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$279.65
|
| Rate for Payer: Vantage Medical Group Senior |
$279.65
|
|
|
HC INDR MERIT PRELUDE SNAP 13CM
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC INDR MERIT PRELUDE SNAP 25CM
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
|
|
HC INDR MERIT PRELUDE SNAP 25CM
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.62
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO |
$264.32
|
| Rate for Payer: Cigna of CA PPO |
$305.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
