|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$1,264.80 |
| Rate for Payer: Adventist Health Commercial |
$610.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$861.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.14
|
| Rate for Payer: Blue Shield of California EPN |
$723.17
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,264.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,041.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.80
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$1,264.80 |
| Rate for Payer: Adventist Health Commercial |
$610.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$861.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.14
|
| Rate for Payer: Blue Shield of California EPN |
$723.17
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,264.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,041.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,041.60
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$744.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.80
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$533.76 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,288.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,080.86
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$533.76 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,288.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,080.86
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.76
|
| Rate for Payer: Blue Shield of California Commercial |
$384.50
|
| Rate for Payer: Blue Shield of California EPN |
$253.21
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.76
|
| Rate for Payer: Blue Shield of California Commercial |
$384.50
|
| Rate for Payer: Blue Shield of California EPN |
$253.21
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$471.47
|
| Rate for Payer: Blue Shield of California Commercial |
$600.73
|
| Rate for Payer: Blue Shield of California EPN |
$395.60
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,009.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$471.47
|
| Rate for Payer: Blue Shield of California Commercial |
$600.73
|
| Rate for Payer: Blue Shield of California EPN |
$395.60
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,009.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,386.80 |
| Max. Negotiated Rate |
$8,453.25 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,760.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,339.41
|
| Rate for Payer: Blue Shield of California EPN |
$4,833.27
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,797.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,961.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,386.80 |
| Max. Negotiated Rate |
$8,453.25 |
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,760.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,339.41
|
| Rate for Payer: Blue Shield of California EPN |
$4,833.27
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,797.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,961.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,961.50
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,633.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC LAA PERI DEVICE LEAK CLOSURE
|
Facility
|
OP
|
$21,755.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820299
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$18,491.75 |
| Rate for Payer: Adventist Health Commercial |
$4,351.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14,269.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,359.75
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Cigna of CA HMO |
$13,923.20
|
| Rate for Payer: Cigna of CA PPO |
$16,098.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$18,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,053.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,510.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,221.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$17,404.00
|
| Rate for Payer: Networks By Design Commercial |
$14,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$18,491.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC LAA PERI DEVICE LEAK CLOSURE
|
Facility
|
IP
|
$21,755.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820299
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,351.00 |
| Max. Negotiated Rate |
$18,491.75 |
| Rate for Payer: Adventist Health Commercial |
$4,351.00
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,702.00
|
| Rate for Payer: Galaxy Health WC |
$18,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,510.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,288.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,466.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,221.20
|
| Rate for Payer: Multiplan Commercial |
$17,404.00
|
| Rate for Payer: Networks By Design Commercial |
$14,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$18,491.75
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$64.97 |
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
|
|
HC LAB REF ACH RECEPTOR MODULATING ABS
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
