|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$196.35 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.80
|
| Rate for Payer: Blue Shield of California Commercial |
$170.48
|
| Rate for Payer: Blue Shield of California EPN |
$112.27
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$196.35 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.80
|
| Rate for Payer: Blue Shield of California Commercial |
$170.48
|
| Rate for Payer: Blue Shield of California EPN |
$112.27
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| 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 |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| 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 |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.17
|
| Rate for Payer: Blue Shield of California Commercial |
$504.79
|
| Rate for Payer: Blue Shield of California EPN |
$332.42
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| 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 Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| 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 |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.17
|
| Rate for Payer: Blue Shield of California Commercial |
$504.79
|
| Rate for Payer: Blue Shield of California EPN |
$332.42
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| 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 Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| 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 |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.25
|
| Rate for Payer: Blue Shield of California Commercial |
$104.80
|
| Rate for Payer: Blue Shield of California EPN |
$69.01
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.25
|
| Rate for Payer: Blue Shield of California Commercial |
$104.80
|
| Rate for Payer: Blue Shield of California EPN |
$69.01
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$116.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: EPIC Health Plan Senior |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$141.16
|
| Rate for Payer: Blue Shield of California EPN |
$93.26
|
| Rate for Payer: Cash Price |
$116.05
|
| Rate for Payer: Cash Price |
$116.05
|
| Rate for Payer: Cigna of CA HMO |
$135.04
|
| Rate for Payer: Cigna of CA PPO |
$156.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Senior |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
IP
|
$6,338.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,387.30 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Cash Price |
$3,485.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| Rate for Payer: Multiplan Commercial |
$5,070.40
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,485.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,753.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| 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 |
$3,485.90
|
| Rate for Payer: Cash Price |
$3,485.90
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,387.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,387.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,436.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,436.60
|
| Rate for Payer: Multiplan Commercial |
$5,070.40
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,387.30
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Cash Price |
$597.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$3,917.54 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$815.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,917.54
|
| Rate for Payer: Blue Shield of California Commercial |
$665.24
|
| Rate for Payer: Blue Shield of California EPN |
$439.15
|
| Rate for Payer: Cash Price |
$597.85
|
| Rate for Payer: Cash Price |
$597.85
|
| Rate for Payer: Cigna of CA HMO |
$695.68
|
| Rate for Payer: Cigna of CA PPO |
$804.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$548.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.90
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$652.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$543.50
|
| Rate for Payer: United Healthcare All Other HMO |
$543.50
|
| Rate for Payer: United Healthcare HMO Rider |
$543.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$543.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.95
|
| Rate for Payer: Vantage Medical Group Senior |
$923.95
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$576.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$3,356.24 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$611.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,356.24
|
| Rate for Payer: Blue Shield of California Commercial |
$570.38
|
| Rate for Payer: Blue Shield of California EPN |
$376.53
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$576.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$652.40
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.95
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
