|
HC MR SAFETY IMPL ELECTRONICS PREP SUP PHYS/QHP
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
908801504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$640.23 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$640.23
|
| Rate for Payer: Blue Shield of California Commercial |
$151.78
|
| Rate for Payer: Blue Shield of California EPN |
$100.19
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.45
|
| Rate for Payer: EPIC Health Plan Senior |
$116.63
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.28
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.00
|
| Rate for Payer: United Healthcare All Other HMO |
$124.00
|
| Rate for Payer: United Healthcare HMO Rider |
$124.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.29
|
| Rate for Payer: Vantage Medical Group Senior |
$116.63
|
|
|
HC MR SAFETY IMPL ELECTRONICS PREP SUP PHYS/QHP
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
908801504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC MR SAFETY IMPL POS/IMMOBL SUP PHYS/QHP
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
908801505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$980.17 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$980.17
|
| Rate for Payer: Blue Shield of California Commercial |
$98.53
|
| Rate for Payer: Blue Shield of California EPN |
$65.04
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cigna of CA HMO |
$103.04
|
| Rate for Payer: Cigna of CA PPO |
$119.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.50
|
| Rate for Payer: United Healthcare All Other HMO |
$80.50
|
| Rate for Payer: United Healthcare HMO Rider |
$80.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC MR SAFETY IMPL POS/IMMOBL SUP PHYS/QHP
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
908801505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC MR SAFETY MED PHYSICS EXAM CUSTOM PLN/MTR
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
908801503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$555.05 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
|
|
HC MR SAFETY MED PHYSICS EXAM CUSTOM PLN/MTR
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
908801503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$1,519.32 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,519.32
|
| Rate for Payer: Blue Shield of California Commercial |
$399.64
|
| Rate for Payer: Blue Shield of California EPN |
$263.81
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO |
$417.92
|
| Rate for Payer: Cigna of CA PPO |
$483.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.50
|
| Rate for Payer: United Healthcare All Other HMO |
$326.50
|
| Rate for Payer: United Healthcare HMO Rider |
$326.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MSS DV8 ESOPHAGEAL RETRACTOR
|
Facility
|
IP
|
$3,101.00
|
|
| Hospital Charge Code |
906812704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$2,635.85 |
| Rate for Payer: Adventist Health Commercial |
$620.20
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,919.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.24
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
|
|
HC MSS DV8 ESOPHAGEAL RETRACTOR
|
Facility
|
OP
|
$3,101.00
|
|
| Hospital Charge Code |
906812704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$2,635.85 |
| Rate for Payer: Adventist Health Commercial |
$620.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,033.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,705.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,325.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,904.32
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cigna of CA HMO |
$1,984.64
|
| Rate for Payer: Cigna of CA PPO |
$2,294.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,919.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,170.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,170.70
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,550.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,550.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,550.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,550.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.85
|
|
|
HC MTR URN 400ML DRAIN BAG
|
Facility
|
OP
|
$75.69
|
|
| Hospital Charge Code |
901698821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$64.34 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.48
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$48.44
|
| Rate for Payer: Cigna of CA PPO |
$56.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.28
|
| Rate for Payer: EPIC Health Plan Senior |
$30.28
|
| Rate for Payer: Galaxy Health WC |
$64.34
|
| Rate for Payer: Global Benefits Group Commercial |
$45.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.98
|
| Rate for Payer: Multiplan Commercial |
$60.55
|
| Rate for Payer: Networks By Design Commercial |
$49.20
|
| Rate for Payer: Prime Health Services Commercial |
$64.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.84
|
| Rate for Payer: United Healthcare All Other HMO |
$37.84
|
| Rate for Payer: United Healthcare HMO Rider |
$37.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.34
|
| Rate for Payer: Vantage Medical Group Senior |
$64.34
|
|
|
HC MTR URN 400ML DRAIN BAG
|
Facility
|
IP
|
$75.69
|
|
| Hospital Charge Code |
901698821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$64.34 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.28
|
| Rate for Payer: EPIC Health Plan Senior |
$30.28
|
| Rate for Payer: Galaxy Health WC |
$64.34
|
| Rate for Payer: Global Benefits Group Commercial |
$45.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.17
|
| Rate for Payer: Multiplan Commercial |
$60.55
|
| Rate for Payer: Networks By Design Commercial |
$49.20
|
| Rate for Payer: Prime Health Services Commercial |
$64.34
|
|
|
HC MTR URN 400ML DRAIN BAG L/F LL
|
Facility
|
IP
|
$56.66
|
|
| Hospital Charge Code |
901607518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.66
|
| Rate for Payer: EPIC Health Plan Senior |
$22.66
|
| Rate for Payer: Galaxy Health WC |
$48.16
|
| Rate for Payer: Global Benefits Group Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$45.33
|
| Rate for Payer: Networks By Design Commercial |
$36.83
|
| Rate for Payer: Prime Health Services Commercial |
$48.16
|
|
|
HC MTR URN 400ML DRAIN BAG L/F LL
|
Facility
|
OP
|
$56.66
|
|
| Hospital Charge Code |
901607518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.79
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna of CA HMO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$41.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.66
|
| Rate for Payer: EPIC Health Plan Senior |
$22.66
|
| Rate for Payer: Galaxy Health WC |
$48.16
|
| Rate for Payer: Global Benefits Group Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$45.33
|
| Rate for Payer: Networks By Design Commercial |
$36.83
|
| Rate for Payer: Prime Health Services Commercial |
$48.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.33
|
| Rate for Payer: United Healthcare All Other HMO |
$28.33
|
| Rate for Payer: United Healthcare HMO Rider |
$28.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.16
|
| Rate for Payer: Vantage Medical Group Senior |
$48.16
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,373.28 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,314.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,222.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,780.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,728.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,005.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,373.28 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,314.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,222.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,780.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,728.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,005.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.80
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.00
|
| Rate for Payer: United Healthcare All Other HMO |
$78.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.13
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.65
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.65
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
