|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| 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 SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
915352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.25
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.25
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
915352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| 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 SUTR AND STPL REMOVAL NOT REQ ANES
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
907205854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$654.30 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Central Health Plan Commercial |
$581.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$508.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$654.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$461.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$428.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.40
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
|
|
HC SUTR AND STPL REMOVAL NOT REQ ANES
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
907205854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$617.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$399.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$545.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$352.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.90
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Central Health Plan Commercial |
$581.60
|
| Rate for Payer: Cigna of CA HMO |
$465.28
|
| Rate for Payer: Cigna of CA PPO |
$537.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$617.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$617.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$617.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$508.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$654.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$461.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$428.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$508.90
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
| Rate for Payer: Riverside University Health System MISP |
$290.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.50
|
| 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 |
$617.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$617.95
|
| Rate for Payer: Vantage Medical Group Senior |
$617.95
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,383.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,977.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Cigna of CA HMO |
$5,100.80
|
| Rate for Payer: Cigna of CA PPO |
$5,897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,774.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,774.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,579.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,060.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,893.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,702.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,188.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,985.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,985.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,985.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,985.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,774.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,383.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,977.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Cigna of CA HMO |
$5,100.80
|
| Rate for Payer: Cigna of CA PPO |
$5,897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,774.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,774.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,579.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,060.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,893.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,702.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,188.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,985.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,985.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,985.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,985.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,774.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,774.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,579.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,060.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,702.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,579.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,060.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,702.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$752.40 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$668.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$585.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$334.40
|
| Rate for Payer: Galaxy Health WC |
$710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$501.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$752.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$530.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$493.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: Networks By Design Commercial |
$543.40
|
| Rate for Payer: Prime Health Services Commercial |
$710.60
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$404.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$486.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$668.80
|
| Rate for Payer: Cigna of CA HMO |
$535.04
|
| Rate for Payer: Cigna of CA PPO |
$618.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$710.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$585.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$334.40
|
| Rate for Payer: Galaxy Health WC |
$710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$501.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$752.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$530.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$303.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$493.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: Networks By Design Commercial |
$543.40
|
| Rate for Payer: Prime Health Services Commercial |
$710.60
|
| Rate for Payer: Riverside University Health System MISP |
$334.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$501.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.00
|
| 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 |
$710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$710.60
|
|
|
HC SUTR/STPL RMVL REQUIRING ANES
|
Facility
|
OP
|
$7,970.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
907201033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Cigna of CA HMO |
$5,100.80
|
| Rate for Payer: Cigna of CA PPO |
$5,897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,579.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,060.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,985.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC SUTR/STPL RMVL REQUIRING ANES
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
907201033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.00
|
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,579.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,060.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,702.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC SUTR VICRYL 5-0 PS-2 18" UNDYE
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.85
|
| Rate for Payer: Blue Shield of California Commercial |
$27.08
|
| Rate for Payer: Blue Shield of California EPN |
$17.05
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Riverside University Health System MISP |
$17.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC SUTR VICRYL 5-0 PS-2 18" UNDYE
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC SUTURE BONE WAX 2.5G
|
Facility
|
OP
|
$50.35
|
|
| Hospital Charge Code |
901604011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$45.31 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.29
|
| Rate for Payer: Blue Shield of California Commercial |
$31.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Central Health Plan Commercial |
$40.28
|
| Rate for Payer: Cigna of CA HMO |
$32.22
|
| Rate for Payer: Cigna of CA PPO |
$37.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$37.76
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
| Rate for Payer: Riverside University Health System MISP |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.18
|
| Rate for Payer: United Healthcare All Other HMO |
$25.18
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.80
|
| Rate for Payer: Vantage Medical Group Senior |
$42.80
|
|
|
HC SUTURE BONE WAX 2.5G
|
Facility
|
IP
|
$50.35
|
|
| Hospital Charge Code |
901604011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$45.31 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Central Health Plan Commercial |
$40.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Multiplan Commercial |
$37.76
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
|
|
HC SUTURE CHROMIC 0 CT-1 105252
|
Facility
|
IP
|
$27.55
|
|
| Hospital Charge Code |
901694630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Adventist Health Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Senior |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$23.42
|
| Rate for Payer: Global Benefits Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$20.66
|
| Rate for Payer: Networks By Design Commercial |
$17.91
|
| Rate for Payer: Prime Health Services Commercial |
$23.42
|
|
|
HC SUTURE CHROMIC 0 CT-1 105252
|
Facility
|
OP
|
$27.55
|
|
| Hospital Charge Code |
901694630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Adventist Health Commercial |
$5.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.03
|
| Rate for Payer: Blue Shield of California Commercial |
$17.47
|
| Rate for Payer: Blue Shield of California EPN |
$10.99
|
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.04
|
| Rate for Payer: Cigna of CA HMO |
$17.63
|
| Rate for Payer: Cigna of CA PPO |
$20.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Senior |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$23.42
|
| Rate for Payer: Global Benefits Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.29
|
| Rate for Payer: Multiplan Commercial |
$20.66
|
| Rate for Payer: Networks By Design Commercial |
$17.91
|
| Rate for Payer: Prime Health Services Commercial |
$23.42
|
| Rate for Payer: Riverside University Health System MISP |
$11.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO |
$13.78
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.42
|
| Rate for Payer: Vantage Medical Group Senior |
$23.42
|
|
|
HC SUTURE CHROMIC 0 CT-2 104499
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901694858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.41
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.63
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Riverside University Health System MISP |
$12.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC SUTURE CHROMIC 0 CT-2 104499
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901694858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC SUTURE CHROMIC 0 SH 178211
|
Facility
|
IP
|
$21.16
|
|
| Hospital Charge Code |
901694861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC SUTURE CHROMIC 0 SH 178211
|
Facility
|
OP
|
$21.16
|
|
| Hospital Charge Code |
901694861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Riverside University Health System MISP |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC SUTURE CHROMIC 1-0 27" 100173
|
Facility
|
OP
|
$28.62
|
|
| Hospital Charge Code |
901694628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.65
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.42
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Cigna of CA HMO |
$18.32
|
| Rate for Payer: Cigna of CA PPO |
$21.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.03
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
| Rate for Payer: Riverside University Health System MISP |
$11.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.31
|
| Rate for Payer: United Healthcare HMO Rider |
$14.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.33
|
| Rate for Payer: Vantage Medical Group Senior |
$24.33
|
|
