|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.54 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: Cigna of CA HMO |
$1,294.08
|
| Rate for Payer: Cigna of CA PPO |
$1,496.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC PVA PARTICLES
|
Facility
|
OP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$957.95 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$619.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$845.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$652.76
|
| Rate for Payer: Blue Shield of California Commercial |
$831.73
|
| Rate for Payer: Blue Shield of California EPN |
$547.72
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO |
$788.90
|
| Rate for Payer: Cigna of CA PPO |
$788.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$957.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$957.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$957.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$450.80
|
| Rate for Payer: Galaxy Health WC |
$957.95
|
| Rate for Payer: Global Benefits Group Commercial |
$676.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$788.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$788.90
|
| Rate for Payer: Multiplan Commercial |
$901.60
|
| Rate for Payer: Networks By Design Commercial |
$563.50
|
| Rate for Payer: Prime Health Services Commercial |
$957.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$676.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$676.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.96
|
| Rate for Payer: United Healthcare All Other HMO |
$411.69
|
| Rate for Payer: United Healthcare HMO Rider |
$402.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$957.95
|
| Rate for Payer: Vantage Medical Group Senior |
$957.95
|
|
|
HC PVA PARTICLES
|
Facility
|
IP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO |
$788.90
|
| Rate for Payer: Cigna of CA PPO |
$788.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$450.80
|
| Rate for Payer: Galaxy Health WC |
$957.95
|
| Rate for Payer: Global Benefits Group Commercial |
$676.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.48
|
| Rate for Payer: Multiplan Commercial |
$901.60
|
| Rate for Payer: Networks By Design Commercial |
$563.50
|
| Rate for Payer: Prime Health Services Commercial |
$957.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.96
|
| Rate for Payer: United Healthcare All Other HMO |
$411.69
|
| Rate for Payer: United Healthcare HMO Rider |
$402.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.09
|
|
|
HC PWRWAND CATH ED STERILE 3FR
|
Facility
|
IP
|
$440.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Adventist Health Commercial |
$88.19
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.39
|
| Rate for Payer: EPIC Health Plan Senior |
$176.39
|
| Rate for Payer: Galaxy Health WC |
$374.82
|
| Rate for Payer: Global Benefits Group Commercial |
$264.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.83
|
| Rate for Payer: Multiplan Commercial |
$352.78
|
| Rate for Payer: Networks By Design Commercial |
$286.63
|
| Rate for Payer: Prime Health Services Commercial |
$374.82
|
|
|
HC PWRWAND CATH ED STERILE 3FR
|
Facility
|
OP
|
$440.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Adventist Health Commercial |
$88.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.80
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cigna of CA HMO |
$282.22
|
| Rate for Payer: Cigna of CA PPO |
$326.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.39
|
| Rate for Payer: EPIC Health Plan Senior |
$176.39
|
| Rate for Payer: Galaxy Health WC |
$374.82
|
| Rate for Payer: Global Benefits Group Commercial |
$264.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.68
|
| Rate for Payer: Multiplan Commercial |
$352.78
|
| Rate for Payer: Networks By Design Commercial |
$286.63
|
| Rate for Payer: Prime Health Services Commercial |
$374.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.49
|
| Rate for Payer: United Healthcare All Other HMO |
$220.49
|
| Rate for Payer: United Healthcare HMO Rider |
$220.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.82
|
| Rate for Payer: Vantage Medical Group Senior |
$374.82
|
|
|
HC PWRWAND XL 3FR 6CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL 3FR 6CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.53
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.10
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.53
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.10
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Adventist Health Commercial |
$83.52
|
| Rate for Payer: Cash Price |
$187.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Senior |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.22
|
| Rate for Payer: Multiplan Commercial |
$334.08
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
OP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Adventist Health Commercial |
$83.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.45
|
| Rate for Payer: Cash Price |
$187.92
|
| Rate for Payer: Cigna of CA HMO |
$267.26
|
| Rate for Payer: Cigna of CA PPO |
$309.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$354.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Senior |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.32
|
| Rate for Payer: Multiplan Commercial |
$334.08
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.80
|
| Rate for Payer: United Healthcare All Other HMO |
$208.80
|
| Rate for Payer: United Healthcare HMO Rider |
$208.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.96
|
| Rate for Payer: Vantage Medical Group Senior |
$354.96
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
OP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.62
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: Cigna of CA HMO |
$367.49
|
| Rate for Payer: Cigna of CA PPO |
$424.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$488.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$488.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.94
|
| Rate for Payer: Multiplan Commercial |
$459.36
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO |
$287.10
|
| Rate for Payer: United Healthcare HMO Rider |
$287.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$488.07
|
| Rate for Payer: Vantage Medical Group Senior |
$488.07
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
IP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.81
|
| Rate for Payer: Multiplan Commercial |
$459.36
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.26
|
| Rate for Payer: Blue Shield of California Commercial |
$34.12
|
| Rate for Payer: Blue Shield of California EPN |
$22.54
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC PYRUVATE CSF
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.26
|
| Rate for Payer: Blue Shield of California Commercial |
$34.12
|
| Rate for Payer: Blue Shield of California EPN |
$22.54
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$1,321.75 |
| Rate for Payer: Adventist Health Commercial |
$637.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$900.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.59
|
| Rate for Payer: Blue Shield of California EPN |
$755.73
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$674.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
915352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
915352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$1,321.75 |
| Rate for Payer: Adventist Health Commercial |
$637.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$900.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.59
|
| Rate for Payer: Blue Shield of California EPN |
$755.73
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$674.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
