|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$30,959.55 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$20,032.65
|
| Rate for Payer: Cash Price |
$20,032.65
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,741.52
|
| Rate for Payer: Multiplan Commercial |
$29,138.40
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,741.52 |
| Max. Negotiated Rate |
$30,959.55 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,096.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26,880.17
|
| Rate for Payer: Blue Shield of California EPN |
$17,701.58
|
| Rate for Payer: Cash Price |
$20,032.65
|
| Rate for Payer: Cash Price |
$20,032.65
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,201.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,741.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$29,138.40
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,159.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,990.08 |
| Max. Negotiated Rate |
$7,048.20 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,802.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6,119.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,029.91
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,182.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,804.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,159.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,990.08 |
| Max. Negotiated Rate |
$7,048.20 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,802.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6,119.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,029.91
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cash Price |
$4,560.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,182.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,804.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,175.15
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,042.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,175.15
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,042.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$950.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,007.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$943.26
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$950.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other HMO |
$768.00
|
| Rate for Payer: United Healthcare HMO Rider |
$768.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
IP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,125.37
|
| Rate for Payer: Cash Price |
$1,125.37
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,364.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,266.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.07
|
| Rate for Payer: Multiplan Commercial |
$1,636.90
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
OP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,739.21 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,534.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,185.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,510.04
|
| Rate for Payer: Blue Shield of California EPN |
$994.42
|
| Rate for Payer: Cash Price |
$1,125.37
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,364.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,266.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.29
|
| Rate for Payer: Multiplan Commercial |
$1,636.90
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,227.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,227.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.21
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
IP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$430.40
|
| Rate for Payer: Cash Price |
$430.40
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.81
|
| Rate for Payer: Multiplan Commercial |
$626.04
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
OP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$665.17 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.25
|
| Rate for Payer: Blue Shield of California Commercial |
$577.52
|
| Rate for Payer: Blue Shield of California EPN |
$380.32
|
| Rate for Payer: Cash Price |
$430.40
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$665.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$665.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$665.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.78
|
| Rate for Payer: Multiplan Commercial |
$626.04
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$665.17
|
| Rate for Payer: Vantage Medical Group Senior |
$665.17
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
OP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$984.93 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$637.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$869.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$671.14
|
| Rate for Payer: Blue Shield of California Commercial |
$855.15
|
| Rate for Payer: Blue Shield of California EPN |
$563.15
|
| Rate for Payer: Cash Price |
$637.31
|
| Rate for Payer: Cigna of CA HMO |
$811.12
|
| Rate for Payer: Cigna of CA PPO |
$811.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.50
|
| Rate for Payer: EPIC Health Plan Senior |
$463.50
|
| Rate for Payer: Galaxy Health WC |
$984.93
|
| Rate for Payer: Global Benefits Group Commercial |
$695.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$811.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$811.12
|
| Rate for Payer: Multiplan Commercial |
$926.99
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$695.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$695.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Other HMO |
$423.29
|
| Rate for Payer: United Healthcare HMO Rider |
$414.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.93
|
| Rate for Payer: Vantage Medical Group Senior |
$984.93
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
IP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$637.31
|
| Rate for Payer: Cash Price |
$637.31
|
| Rate for Payer: Cigna of CA HMO |
$811.12
|
| Rate for Payer: Cigna of CA PPO |
$811.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.50
|
| Rate for Payer: EPIC Health Plan Senior |
$463.50
|
| Rate for Payer: Galaxy Health WC |
$984.93
|
| Rate for Payer: Global Benefits Group Commercial |
$695.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.10
|
| Rate for Payer: Multiplan Commercial |
$926.99
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Other HMO |
$423.29
|
| Rate for Payer: United Healthcare HMO Rider |
$414.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.49
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
OP
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$1,146.88 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,011.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$781.50
|
| Rate for Payer: Blue Shield of California Commercial |
$995.76
|
| Rate for Payer: Blue Shield of California EPN |
$655.75
|
| Rate for Payer: Cash Price |
$742.10
|
| Rate for Payer: Cigna of CA HMO |
$944.49
|
| Rate for Payer: Cigna of CA PPO |
$944.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,146.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,146.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.71
|
| Rate for Payer: EPIC Health Plan Senior |
$539.71
|
| Rate for Payer: Galaxy Health WC |
$1,146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$809.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$944.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$944.49
|
| Rate for Payer: Multiplan Commercial |
$1,079.42
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$809.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.38
|
| Rate for Payer: United Healthcare All Other HMO |
$492.89
|
| Rate for Payer: United Healthcare HMO Rider |
$482.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,146.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1,146.88
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
IP
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$742.10
|
| Rate for Payer: Cash Price |
$742.10
|
| Rate for Payer: Cigna of CA HMO |
$944.49
|
| Rate for Payer: Cigna of CA PPO |
$944.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.71
|
| Rate for Payer: EPIC Health Plan Senior |
$539.71
|
| Rate for Payer: Galaxy Health WC |
$1,146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$809.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.82
|
| Rate for Payer: Multiplan Commercial |
$1,079.42
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.38
|
| Rate for Payer: United Healthcare All Other HMO |
$492.89
|
| Rate for Payer: United Healthcare HMO Rider |
$482.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.89
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
IP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$197.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$542.53
|
| Rate for Payer: Cash Price |
$542.53
|
| Rate for Payer: Cigna of CA HMO |
$690.49
|
| Rate for Payer: Cigna of CA PPO |
$690.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.57
|
| Rate for Payer: EPIC Health Plan Senior |
$394.57
|
| Rate for Payer: Galaxy Health WC |
$838.46
|
| Rate for Payer: Global Benefits Group Commercial |
$591.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$375.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.74
|
| Rate for Payer: Multiplan Commercial |
$789.14
|
| Rate for Payer: Networks By Design Commercial |
$493.21
|
| Rate for Payer: Prime Health Services Commercial |
$838.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.20
|
| Rate for Payer: United Healthcare All Other HMO |
$360.34
|
| Rate for Payer: United Healthcare HMO Rider |
$352.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$323.05
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
OP
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$569.57 |
| Rate for Payer: Adventist Health Commercial |
$134.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.11
|
| Rate for Payer: Blue Shield of California Commercial |
$494.52
|
| Rate for Payer: Blue Shield of California EPN |
$325.66
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cigna of CA HMO |
$469.06
|
| Rate for Payer: Cigna of CA PPO |
$469.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.03
|
| Rate for Payer: EPIC Health Plan Senior |
$268.03
|
| Rate for Payer: Galaxy Health WC |
$569.57
|
| Rate for Payer: Global Benefits Group Commercial |
$402.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$469.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$469.06
|
| Rate for Payer: Multiplan Commercial |
$536.06
|
| Rate for Payer: Networks By Design Commercial |
$335.04
|
| Rate for Payer: Prime Health Services Commercial |
$569.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.48
|
| Rate for Payer: United Healthcare All Other HMO |
$244.78
|
| Rate for Payer: United Healthcare HMO Rider |
$239.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.57
|
| Rate for Payer: Vantage Medical Group Senior |
$569.57
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
IP
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$134.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cigna of CA HMO |
$469.06
|
| Rate for Payer: Cigna of CA PPO |
$469.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.03
|
| Rate for Payer: EPIC Health Plan Senior |
$268.03
|
| Rate for Payer: Galaxy Health WC |
$569.57
|
| Rate for Payer: Global Benefits Group Commercial |
$402.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.82
|
| Rate for Payer: Multiplan Commercial |
$536.06
|
| Rate for Payer: Networks By Design Commercial |
$335.04
|
| Rate for Payer: Prime Health Services Commercial |
$569.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.48
|
| Rate for Payer: United Healthcare All Other HMO |
$244.78
|
| Rate for Payer: United Healthcare HMO Rider |
$239.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.45
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
OP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$838.46 |
| Rate for Payer: Adventist Health Commercial |
$197.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$739.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$571.33
|
| Rate for Payer: Blue Shield of California Commercial |
$727.98
|
| Rate for Payer: Blue Shield of California EPN |
$479.40
|
| Rate for Payer: Cash Price |
$542.53
|
| Rate for Payer: Cigna of CA HMO |
$690.49
|
| Rate for Payer: Cigna of CA PPO |
$690.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.57
|
| Rate for Payer: EPIC Health Plan Senior |
$394.57
|
| Rate for Payer: Galaxy Health WC |
$838.46
|
| Rate for Payer: Global Benefits Group Commercial |
$591.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$375.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.49
|
| Rate for Payer: Multiplan Commercial |
$789.14
|
| Rate for Payer: Networks By Design Commercial |
$493.21
|
| Rate for Payer: Prime Health Services Commercial |
$838.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$591.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$591.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.20
|
| Rate for Payer: United Healthcare All Other HMO |
$360.34
|
| Rate for Payer: United Healthcare HMO Rider |
$352.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$323.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.46
|
| Rate for Payer: Vantage Medical Group Senior |
$838.46
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$8,306.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,568.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,229.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: Cigna of CA HMO |
$5,315.84
|
| Rate for Payer: Cigna of CA PPO |
$6,146.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,060.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,060.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,814.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,814.20
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,060.10
|
|
