|
HC WHO W/JOINT(S) CF
|
Facility
IP
|
$991.00
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
903203915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.20 |
| Max. Negotiated Rate |
$891.90 |
| Rate for Payer: Blue Shield of California EPN |
$529.19
|
| Rate for Payer: Cash Price |
$445.95
|
| Rate for Payer: Central Health Plan Commercial |
$792.80
|
| Rate for Payer: Cigna of CA HMO |
$693.70
|
| Rate for Payer: Cigna of CA PPO |
$693.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$396.40
|
| Rate for Payer: Galaxy Health WC |
$842.35
|
| Rate for Payer: Global Benefits Group Commercial |
$594.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.20
|
| Rate for Payer: Multiplan Commercial |
$743.25
|
| Rate for Payer: Networks By Design Commercial |
$495.50
|
| Rate for Payer: Prime Health Services Commercial |
$842.35
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Blue Shield of California EPN |
$790.32
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$518.00 |
| Max. Negotiated Rate |
$3,579.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,579.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$814.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$716.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$874.38
|
| Rate for Payer: BCBS Transplant Transplant |
$888.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.00
|
| Rate for Payer: Blue Shield of California EPN |
$805.12
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,110.00
|
| Rate for Payer: IEHP medi-cal |
$518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.80
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Riverside University Health MISP |
$592.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.00
|
| Rate for Payer: United Healthcare All Other HMO |
$740.00
|
| Rate for Payer: United Healthcare HMO Rider |
$740.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
|
|
HC WINDOWING OF CAST
|
Facility
IP
|
$932.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$838.80 |
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC WINDOWING OF CAST
|
Facility
OP
|
$932.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$559.20
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$699.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Innovage PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: Riverside University Health MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC WINDOWING OF CAST
|
Facility
OP
|
$932.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$559.20
|
| Rate for Payer: Blue Shield of California Commercial |
$586.23
|
| Rate for Payer: Blue Shield of California EPN |
$455.75
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$699.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: IEHP medi-cal |
$324.84
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Innovage PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: Riverside University Health MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC WINDOWING OF CAST
|
Facility
IP
|
$932.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$838.80 |
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
IP
|
$0.98
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
|
|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
OP
|
$0.98
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: BCBS Transplant Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.74
|
| Rate for Payer: IEHP medi-cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: Riverside University Health MISP |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
IP
|
$3.03
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.97
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
OP
|
$3.03
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: BCBS Transplant Transplant |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.27
|
| Rate for Payer: IEHP medi-cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.97
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: Riverside University Health MISP |
$1.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
|
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: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$2.24
|
| 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 WIPE SUREPREP BARRIER FILM
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| 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: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
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: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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 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: Aetna of CA HMO/PPO |
$9,246.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: BCBS Transplant Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,925.00
|
| Rate for Payer: IEHP medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$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: Cash Price |
$205.20
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$304.15
|
| 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: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.40
|
| Rate for Payer: BCBS Transplant Transplant |
$273.60
|
| Rate for Payer: Blue Shield of California Commercial |
$286.82
|
| Rate for Payer: Blue Shield of California EPN |
$222.98
|
| 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: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$342.00
|
| Rate for Payer: IEHP medi-cal |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$274.80
|
| 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: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$226.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$226.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.41
|
| Rate for Payer: BCBS Transplant Transplant |
$247.20
|
| Rate for Payer: Blue Shield of California Commercial |
$259.15
|
| Rate for Payer: Blue Shield of California EPN |
$201.47
|
| 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: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$309.00
|
| Rate for Payer: IEHP medi-cal |
$144.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$247.20
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$350.20
|
| Rate for Payer: Vantage Medical Group Senior |
$350.20
|
|
|
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 |
$18,635.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,635.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,602.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,330.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,622.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1,747.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,584.67
|
| Rate for Payer: Cash Price |
$1,310.85
|
| 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: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,184.75
|
| Rate for Payer: IEHP medi-cal |
$1,019.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,942.97
|
| 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: Riverside University Health 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 |
$1,456.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,456.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,456.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,476.05
|
|
|
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: Blue Shield of California EPN |
$1,555.54
|
| 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: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,942.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.60
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
|
|
HC WORK HARD/COND ADDL 1HR OT
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903207546
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC WORK HARD/COND ADDL 1HR OT
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903207546
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$207.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$156.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$171.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$213.75
|
| Rate for Payer: IEHP medi-cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.85
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: Riverside University Health MISP |
$114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC WORK HARDENING ADDL 1HR PT
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903200155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC WORK HARDENING ADDL 1HR PT
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903200155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$207.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$156.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$171.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$213.75
|
| Rate for Payer: IEHP medi-cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.85
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: Riverside University Health MISP |
$114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
