|
HC SUBSTERN ICD LEAD REPOS
|
Facility
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$71,692.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$47,794.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$59,743.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: IEHP medi-cal |
$8,095.79
|
| Rate for Payer: IEHP Medicare Advantage |
$4,906.54
|
| Rate for Payer: Innovage PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$47,794.80
|
| Rate for Payer: Riverside University Health MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906820277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,931.60 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906820277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$71,692.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$47,794.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$59,743.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: IEHP medi-cal |
$8,095.79
|
| Rate for Payer: IEHP Medicare Advantage |
$4,906.54
|
| Rate for Payer: Innovage PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$47,794.80
|
| Rate for Payer: Riverside University Health MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,574.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: Cigna of CA PPO |
$4,408.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,467.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: IEHP medi-cal |
$8,095.79
|
| Rate for Payer: IEHP Medicare Advantage |
$4,906.54
|
| Rate for Payer: Innovage PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,574.20
|
| Rate for Payer: Riverside University Health MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,191.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,574.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: Cigna of CA PPO |
$4,408.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,467.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: IEHP medi-cal |
$8,095.79
|
| Rate for Payer: IEHP Medicare Advantage |
$4,906.54
|
| Rate for Payer: Innovage PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,574.20
|
| Rate for Payer: Riverside University Health MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,191.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$41,105.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$56,196.73
|
| Rate for Payer: BCBS Transplant Transplant |
$47,794.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$41,105.24
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,492.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$41,105.24
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$59,743.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67,412.59
|
| Rate for Payer: IEHP medi-cal |
$67,823.65
|
| Rate for Payer: IEHP Medicare Advantage |
$41,105.24
|
| Rate for Payer: Innovage PACE Commercial |
$61,657.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,105.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,081.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,081.02
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Preferred Health Network WC |
$57,343.60
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Prime Health Services Medicare |
$43,571.55
|
| Rate for Payer: Prime Health Services WC |
$55,623.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$47,794.80
|
| Rate for Payer: Riverside University Health MISP |
$45,215.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,931.60 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,931.60 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$41,105.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$56,196.73
|
| Rate for Payer: BCBS Transplant Transplant |
$47,794.80
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$41,105.24
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Central Health Plan Commercial |
$63,726.40
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,492.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$41,105.24
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,692.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$59,743.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67,412.59
|
| Rate for Payer: IEHP medi-cal |
$67,823.65
|
| Rate for Payer: IEHP Medicare Advantage |
$41,105.24
|
| Rate for Payer: Innovage PACE Commercial |
$61,657.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,105.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,931.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,081.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,081.02
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Preferred Health Network WC |
$57,343.60
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Prime Health Services Medicare |
$43,571.55
|
| Rate for Payer: Prime Health Services WC |
$55,623.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$47,794.80
|
| Rate for Payer: Riverside University Health MISP |
$45,215.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUDAN BLACK B
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SUDAN BLACK B
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.81
|
| Rate for Payer: BCBS Transplant Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$72.92
|
| Rate for Payer: Blue Shield of California EPN |
$57.35
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$88.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SUDAN BLACK B
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.81
|
| Rate for Payer: BCBS Transplant Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$72.92
|
| Rate for Payer: Blue Shield of California EPN |
$57.35
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$88.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SUDAN BLACK B
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SUPPORT BACK CRISS-CROSS 2XL
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: BCBS Transplant Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$61.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.61
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.50
|
| Rate for Payer: IEHP medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC SUPPORT BACK CRISS-CROSS 2XL
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Blue Shield of California EPN |
$43.79
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SUPPORT BACK CRISS-CROSS LRG
|
Facility
OP
|
$128.59
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.97
|
| Rate for Payer: BCBS Transplant Transplant |
$77.15
|
| Rate for Payer: Blue Shield of California Commercial |
$96.44
|
| Rate for Payer: Blue Shield of California EPN |
$69.95
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$90.01
|
| Rate for Payer: Cigna of CA PPO |
$90.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.44
|
| Rate for Payer: IEHP medi-cal |
$45.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.72
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$64.30
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: Riverside University Health MISP |
$51.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.30
|
| Rate for Payer: United Healthcare All Other HMO |
$64.30
|
| Rate for Payer: United Healthcare HMO Rider |
$64.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.30
|
| Rate for Payer: Vantage Medical Group Senior |
$109.30
|
|
|
HC SUPPORT BACK CRISS-CROSS LRG
|
Facility
IP
|
$128.59
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Blue Shield of California EPN |
$68.67
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$90.01
|
| Rate for Payer: Cigna of CA PPO |
$90.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.72
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$64.30
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
OP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.90 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$145.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.82
|
| Rate for Payer: BCBS Transplant Transplant |
$159.26
|
| Rate for Payer: Blue Shield of California Commercial |
$199.08
|
| Rate for Payer: Blue Shield of California EPN |
$144.40
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$199.08
|
| Rate for Payer: IEHP medi-cal |
$92.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.83
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Riverside University Health MISP |
$106.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.72
|
| Rate for Payer: United Healthcare All Other HMO |
$132.72
|
| Rate for Payer: United Healthcare HMO Rider |
$132.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
IP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Blue Shield of California EPN |
$141.74
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
IP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$90.29 |
| Rate for Payer: Blue Shield of California EPN |
$53.57
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Central Health Plan Commercial |
$80.26
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$75.24
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
OP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$3,944.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,944.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.27
|
| Rate for Payer: BCBS Transplant Transplant |
$60.19
|
| Rate for Payer: Blue Shield of California Commercial |
$75.24
|
| Rate for Payer: Blue Shield of California EPN |
$54.57
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Central Health Plan Commercial |
$80.26
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.24
|
| Rate for Payer: IEHP medi-cal |
$35.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.13
|
| Rate for Payer: Multiplan Commercial |
$75.24
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: Riverside University Health MISP |
$40.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.16
|
| Rate for Payer: United Healthcare All Other HMO |
$50.16
|
| Rate for Payer: United Healthcare HMO Rider |
$50.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.27
|
| Rate for Payer: Vantage Medical Group Senior |
$85.27
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
OP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$1,042.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,042.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.47
|
| Rate for Payer: BCBS Transplant Transplant |
$88.83
|
| Rate for Payer: Blue Shield of California Commercial |
$111.04
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Central Health Plan Commercial |
$118.44
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$111.04
|
| Rate for Payer: IEHP medi-cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.70
|
| Rate for Payer: Multiplan Commercial |
$111.04
|
| Rate for Payer: Networks By Design Commercial |
$74.02
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: Riverside University Health MISP |
$59.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.02
|
| Rate for Payer: United Healthcare All Other HMO |
$74.02
|
| Rate for Payer: United Healthcare HMO Rider |
$74.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.84
|
| Rate for Payer: Vantage Medical Group Senior |
$125.84
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
IP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Blue Shield of California EPN |
$79.06
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Central Health Plan Commercial |
$118.44
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.61
|
| Rate for Payer: Multiplan Commercial |
$111.04
|
| Rate for Payer: Networks By Design Commercial |
$74.02
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
|
