|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$6,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,623.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
OP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$8,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,181.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,065.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,301.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,215.85
|
| Rate for Payer: Blue Shield of California Commercial |
$7,281.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,747.68
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,536.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,007.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,007.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,478.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,589.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,830.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,884.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,594.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,594.00
|
| Rate for Payer: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,768.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,652.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,535.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3,366.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,085.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,007.00
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
IP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$8,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,281.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,747.68
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,536.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,478.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,589.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,830.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,535.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3,366.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,085.05
|
|
|
HC STNT WALL CAROTID
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$5,782.50 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,966.52
|
| Rate for Payer: Blue Shield of California EPN |
$3,238.20
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,140.00
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,782.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,447.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,977.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.00
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2,347.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.19
|
|
|
HC STNT WALL CAROTID
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$5,782.50 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,533.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,818.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,933.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,557.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,966.52
|
| Rate for Payer: Blue Shield of California EPN |
$3,238.20
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,140.00
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,461.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,461.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,782.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,212.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,447.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,977.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,497.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,497.50
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,570.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2,347.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,461.25
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$5,098.50 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,379.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,855.16
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,532.00
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,098.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,506.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,126.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2,069.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,024.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,855.29
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$5,098.50 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,248.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,586.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,136.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4,379.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,855.16
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,532.00
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,815.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,815.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,098.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,832.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,506.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,965.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,965.50
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,266.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,126.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2,069.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,024.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,855.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,815.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,542.50 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,553.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,118.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,289.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,564.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,183.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,260.00
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,401.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,401.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,412.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,748.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,977.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,977.50
|
| Rate for Payer: Multiplan Commercial |
$2,118.75
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,695.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,695.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,031.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,009.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,401.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,542.50 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,183.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,260.00
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,748.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Multiplan Commercial |
$2,118.75
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,031.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,009.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.19
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
905350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
915350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.33
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Riverside University Health System MISP |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
905350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.33
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Riverside University Health System MISP |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
915350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
915352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
915352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.97 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.35
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.97 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.35
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.15
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC STRAP CLAVICLE MEDIUM
|
Facility
|
IP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607796
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Adventist Health Commercial |
$7.46
|
| Rate for Payer: Blue Shield of California Commercial |
$28.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.80
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.63
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
|
|
HC STRAP CLAVICLE MEDIUM
|
Facility
|
OP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607796
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.91
|
| Rate for Payer: Blue Shield of California Commercial |
$28.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.80
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.89
|
| Rate for Payer: InnovAge PACE Commercial |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.12
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Riverside University Health System MISP |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.63
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
|
HC STRAP CLAVICLE SMALL
|
Facility
|
OP
|
$73.06
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$29.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.91
|
| Rate for Payer: Blue Shield of California Commercial |
$56.48
|
| Rate for Payer: Blue Shield of California EPN |
$36.82
|
| Rate for Payer: Cash Price |
$40.18
|
| Rate for Payer: Cash Price |
$40.18
|
| Rate for Payer: Central Health Plan Commercial |
$58.45
|
| Rate for Payer: Cigna of CA HMO |
$51.14
|
| Rate for Payer: Cigna of CA PPO |
$51.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.22
|
| Rate for Payer: EPIC Health Plan Senior |
$29.22
|
| Rate for Payer: Galaxy Health WC |
$62.10
|
| Rate for Payer: Global Benefits Group Commercial |
$43.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.89
|
| Rate for Payer: InnovAge PACE Commercial |
$36.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.14
|
| Rate for Payer: Multiplan Commercial |
$54.80
|
| Rate for Payer: Networks By Design Commercial |
$36.53
|
| Rate for Payer: Prime Health Services Commercial |
$62.10
|
| Rate for Payer: Riverside University Health System MISP |
$29.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.42
|
| Rate for Payer: United Healthcare All Other HMO |
$26.69
|
| Rate for Payer: United Healthcare HMO Rider |
$26.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.10
|
| Rate for Payer: Vantage Medical Group Senior |
$62.10
|
|
|
HC STRAP CLAVICLE SMALL
|
Facility
|
IP
|
$73.06
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$65.75 |
| Rate for Payer: Adventist Health Commercial |
$14.61
|
| Rate for Payer: Blue Shield of California Commercial |
$56.48
|
| Rate for Payer: Blue Shield of California EPN |
$36.82
|
| Rate for Payer: Cash Price |
$40.18
|
| Rate for Payer: Central Health Plan Commercial |
$58.45
|
| Rate for Payer: Cigna of CA HMO |
$51.14
|
| Rate for Payer: Cigna of CA PPO |
$51.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.22
|
| Rate for Payer: EPIC Health Plan Senior |
$29.22
|
| Rate for Payer: Galaxy Health WC |
$62.10
|
| Rate for Payer: Global Benefits Group Commercial |
$43.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.61
|
| Rate for Payer: Multiplan Commercial |
$54.80
|
| Rate for Payer: Networks By Design Commercial |
$47.49
|
| Rate for Payer: Prime Health Services Commercial |
$62.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.42
|
| Rate for Payer: United Healthcare All Other HMO |
$26.69
|
| Rate for Payer: United Healthcare HMO Rider |
$26.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.93
|
|
|
HC STRAP MONTGOMERY W TWILL 3X7IN
|
Facility
|
OP
|
$26.81
|
|
| Hospital Charge Code |
901607818
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.75
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$21.45
|
| Rate for Payer: Cigna of CA HMO |
$17.16
|
| Rate for Payer: Cigna of CA PPO |
$19.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.79
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.13
|
| Rate for Payer: InnovAge PACE Commercial |
$13.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$20.11
|
| Rate for Payer: Networks By Design Commercial |
$17.43
|
| Rate for Payer: Prime Health Services Commercial |
$22.79
|
| Rate for Payer: Riverside University Health System MISP |
$10.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.79
|
| Rate for Payer: Vantage Medical Group Senior |
$22.79
|
|
|
HC STRAP MONTGOMERY W TWILL 3X7IN
|
Facility
|
IP
|
$26.81
|
|
| Hospital Charge Code |
901607818
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.79
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$20.11
|
| Rate for Payer: Networks By Design Commercial |
$17.43
|
| Rate for Payer: Prime Health Services Commercial |
$22.79
|
|
