|
HC SHOE TRNSFR SOLID STIRRUP EXIS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3620
|
| Hospital Charge Code |
905353620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SHOE TRNSFR SOLID STIRRUP EXIS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3620
|
| Hospital Charge Code |
915353620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SHOE WOMENS OXFORD/BRACE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3214
|
| Hospital Charge Code |
905353214
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.06
|
| 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: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC SHOE WOMENS OXFORD/BRACE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3214
|
| Hospital Charge Code |
905353214
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| 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 |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$460.70 |
| Rate for Payer: Adventist Health Commercial |
$108.40
|
| Rate for Payer: Cash Price |
$298.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Senior |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.08
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$108.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$298.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$406.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$298.10
|
| Rate for Payer: Cash Price |
$298.10
|
| Rate for Payer: Cash Price |
$298.10
|
| Rate for Payer: Cigna of CA HMO |
$346.88
|
| Rate for Payer: Cigna of CA PPO |
$401.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$460.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$460.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Senior |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$289.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.40
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.20
|
| 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 |
$460.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$460.70
|
| Rate for Payer: Vantage Medical Group Senior |
$460.70
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$502.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$532.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.19
|
| Rate for Payer: Blue Shield of California Commercial |
$496.94
|
| Rate for Payer: Blue Shield of California EPN |
$328.05
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cigna of CA HMO |
$519.68
|
| Rate for Payer: Cigna of CA PPO |
$600.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SHOULDER LIMITED
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$418.61
|
| Rate for Payer: Blue Shield of California EPN |
$276.34
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SHOULDER LIMITED
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
|
|
HC SHOWER SHIELD 10X12IN
|
Facility
|
IP
|
$8.77
|
|
| Hospital Charge Code |
901698410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
|
|
HC SHOWER SHIELD 10X12IN
|
Facility
|
OP
|
$8.77
|
|
| Hospital Charge Code |
901698410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.39
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7.45
|
|
|
HC SHOWER SHIELD 7X7IN
|
Facility
|
IP
|
$7.22
|
|
| Hospital Charge Code |
901698408
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Senior |
$2.89
|
| Rate for Payer: Galaxy Health WC |
$6.14
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$4.69
|
| Rate for Payer: Prime Health Services Commercial |
$6.14
|
|
|
HC SHOWER SHIELD 7X7IN
|
Facility
|
OP
|
$7.22
|
|
| Hospital Charge Code |
901698408
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$5.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Senior |
$2.89
|
| Rate for Payer: Galaxy Health WC |
$6.14
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$4.69
|
| Rate for Payer: Prime Health Services Commercial |
$6.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.61
|
| Rate for Payer: United Healthcare All Other HMO |
$3.61
|
| Rate for Payer: United Healthcare HMO Rider |
$3.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.14
|
| Rate for Payer: Vantage Medical Group Senior |
$6.14
|
|
|
HC SHOWER SHIELD 9X9IN
|
Facility
|
IP
|
$7.87
|
|
| Hospital Charge Code |
901698409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Senior |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
|
|
HC SHOWER SHIELD 9X9IN
|
Facility
|
OP
|
$7.87
|
|
| Hospital Charge Code |
901698409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.83
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Senior |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: Vantage Medical Group Senior |
$6.69
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
915353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
915353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.72
|
| Rate for Payer: Blue Shield of California Commercial |
$109.22
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.80
|
| Rate for Payer: Vantage Medical Group Senior |
$125.80
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
905353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
905353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.72
|
| Rate for Payer: Blue Shield of California Commercial |
$109.22
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.80
|
| Rate for Payer: Vantage Medical Group Senior |
$125.80
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
IP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$197.54 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Cash Price |
$127.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.78
|
| Rate for Payer: Multiplan Commercial |
$185.92
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
OP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$197.54 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Cash Price |
$127.82
|
| Rate for Payer: Cigna of CA HMO |
$148.74
|
| Rate for Payer: Cigna of CA PPO |
$171.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.68
|
| Rate for Payer: Multiplan Commercial |
$185.92
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.20
|
| Rate for Payer: United Healthcare All Other HMO |
$116.20
|
| Rate for Payer: United Healthcare HMO Rider |
$116.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.54
|
| Rate for Payer: Vantage Medical Group Senior |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
OP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.27
|
| Rate for Payer: Cash Price |
$118.46
|
| Rate for Payer: Cigna of CA HMO |
$137.85
|
| Rate for Payer: Cigna of CA PPO |
$159.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$172.31
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.69
|
| Rate for Payer: United Healthcare All Other HMO |
$107.69
|
| Rate for Payer: United Healthcare HMO Rider |
$107.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.08
|
| Rate for Payer: Vantage Medical Group Senior |
$183.08
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
IP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Cash Price |
$118.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.69
|
| Rate for Payer: Multiplan Commercial |
$172.31
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
OP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.08
|
| Rate for Payer: Cash Price |
$191.73
|
| Rate for Payer: Cigna of CA HMO |
$223.10
|
| Rate for Payer: Cigna of CA PPO |
$257.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.02
|
| Rate for Payer: Multiplan Commercial |
$278.88
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.30
|
| Rate for Payer: United Healthcare All Other HMO |
$174.30
|
| Rate for Payer: United Healthcare HMO Rider |
$174.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.31
|
| Rate for Payer: Vantage Medical Group Senior |
$296.31
|
|
