|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
|
IP
|
$3.44
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
|
OP
|
$3.44
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
HC WIPE SUREPREP BARRIER FILM
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
HC WIPE SUREPREP BARRIER FILM
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
HC WIRE ABBOTT ASAHI EXTENSION
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812645
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$238.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.78
|
| Rate for Payer: Blue Shield of California Commercial |
$312.56
|
| Rate for Payer: Blue Shield of California EPN |
$196.71
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$313.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Riverside University Health System MISP |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC WIRE ABBOTT ASAHI EXTENSION
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812645
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$313.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC WIRE B/S EMBOLIC FILTERWIRE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$9,246.25 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,246.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC WIRE B/S EMBOLIC FILTERWIRE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.26
|
| Rate for Payer: Blue Shield of California Commercial |
$289.10
|
| Rate for Payer: Blue Shield of California EPN |
$181.94
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$387.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Riverside University Health System MISP |
$182.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.00
|
| Rate for Payer: United Healthcare All Other HMO |
$228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$228.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC WIRE EV3 NITREX 80CM
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$288.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$261.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC WIRE EV3 NITREX 80CM
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.66
|
| Rate for Payer: Blue Shield of California Commercial |
$261.21
|
| Rate for Payer: Blue Shield of California EPN |
$164.39
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: Cigna of CA HMO |
$263.68
|
| Rate for Payer: Cigna of CA PPO |
$304.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$350.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$350.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$288.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$261.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$288.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
| Rate for Payer: Riverside University Health System MISP |
$164.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.00
|
| Rate for Payer: United Healthcare All Other HMO |
$206.00
|
| Rate for Payer: United Healthcare HMO Rider |
$206.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$350.20
|
| Rate for Payer: Vantage Medical Group Senior |
$350.20
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,621.70 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,336.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.15
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,330.40
|
| Rate for Payer: Cigna of CA HMO |
$2,039.10
|
| Rate for Payer: Cigna of CA PPO |
$2,039.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,621.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,718.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.60
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: Networks By Design Commercial |
$1,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.01
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
OP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,621.70 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,184.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,330.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,597.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,336.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.15
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,330.40
|
| Rate for Payer: Cigna of CA HMO |
$2,039.10
|
| Rate for Payer: Cigna of CA PPO |
$2,039.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,476.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,476.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,621.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,849.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,057.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,718.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,039.10
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: Networks By Design Commercial |
$1,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,165.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,747.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,747.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,476.05
|
|
|
HC WND SESSION-IND - IEHP
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
902501302
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$154.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.88
|
| Rate for Payer: Blue Shield of California Commercial |
$239.65
|
| Rate for Payer: Blue Shield of California EPN |
$150.82
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$223.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Riverside University Health System MISP |
$151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.30
|
| Rate for Payer: Vantage Medical Group Senior |
$321.30
|
|
|
HC WND SESSION-IND - IEHP
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
902501302
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$223.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC WORK HARD/COND ADDL 1HR OT
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903207546
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC WORK HARD/COND ADDL 1HR OT
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903207546
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC WORK HARDENING ADDL 1HR PT
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903200155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC WORK HARDENING ADDL 1HR PT
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903200155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC WORK HARDENING INITIAL 2HR OT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903207545
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$573.07 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC WORK HARDENING INITIAL 2HR OT
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903207545
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC WORK HARDENING INITIAL 2HR PT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903200154
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$573.07 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC WORK HARDENING INITIAL 2HR PT
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903200154
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
