|
HC ADAPTER RT ANGLE Y PORT 12" AMT BUTTON
|
Facility
|
IP
|
$66.42
|
|
| Hospital Charge Code |
901698132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Central Health Plan Commercial |
$53.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.57
|
| Rate for Payer: EPIC Health Plan Senior |
$26.57
|
| Rate for Payer: Galaxy Health WC |
$56.46
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.46
|
|
|
HC ADAPTER RT ANGLE Y PORT 12" AMT BUTTON
|
Facility
|
OP
|
$66.42
|
|
| Hospital Charge Code |
901698132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.01
|
| Rate for Payer: Blue Shield of California Commercial |
$40.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.50
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Central Health Plan Commercial |
$53.14
|
| Rate for Payer: Cigna of CA HMO |
$42.51
|
| Rate for Payer: Cigna of CA PPO |
$49.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.57
|
| Rate for Payer: EPIC Health Plan Senior |
$26.57
|
| Rate for Payer: Galaxy Health WC |
$56.46
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.78
|
| Rate for Payer: InnovAge PACE Commercial |
$33.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.49
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.46
|
| Rate for Payer: Riverside University Health System MISP |
$26.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.21
|
| Rate for Payer: United Healthcare All Other HMO |
$33.21
|
| Rate for Payer: United Healthcare HMO Rider |
$33.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.46
|
| Rate for Payer: Vantage Medical Group Senior |
$56.46
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$132.48
|
| Rate for Payer: Cigna of CA PPO |
$153.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.79
|
| Rate for Payer: InnovAge PACE Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
| Rate for Payer: Riverside University Health System MISP |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.20
|
| 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 |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$132.48
|
| Rate for Payer: Cigna of CA PPO |
$153.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.79
|
| Rate for Payer: InnovAge PACE Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
| Rate for Payer: Riverside University Health System MISP |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.20
|
| 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 |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC ADAPTOR BS BRADY
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$698.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$556.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$675.39
|
| Rate for Payer: Blue Shield of California Commercial |
$702.65
|
| Rate for Payer: Blue Shield of California EPN |
$458.85
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA HMO |
$736.00
|
| Rate for Payer: Cigna of CA PPO |
$851.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: InnovAge PACE Commercial |
$575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Riverside University Health System MISP |
$460.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$575.00
|
| Rate for Payer: United Healthcare All Other HMO |
$575.00
|
| Rate for Payer: United Healthcare HMO Rider |
$575.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC ADAPTOR BS BRADY
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
|
|
HC ADAPTOR BS TACHY
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,449.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$1,207.50
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
|
|
HC ADAPTOR BS TACHY
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$977.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$885.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,207.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$779.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.55
|
| Rate for Payer: Blue Shield of California Commercial |
$983.71
|
| Rate for Payer: Blue Shield of California EPN |
$642.39
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,288.00
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,191.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,368.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,368.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,449.00
|
| Rate for Payer: InnovAge PACE Commercial |
$805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$1,207.50
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
| Rate for Payer: Riverside University Health System MISP |
$644.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$966.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$966.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$805.00
|
| Rate for Payer: United Healthcare All Other HMO |
$805.00
|
| Rate for Payer: United Healthcare HMO Rider |
$805.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$805.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,368.50
|
|
|
HC ADAPTOR MED ACCESS 6984M
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$516.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$638.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$412.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.79
|
| Rate for Payer: Blue Shield of California Commercial |
$519.96
|
| Rate for Payer: Blue Shield of California EPN |
$339.55
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Cigna of CA HMO |
$544.64
|
| Rate for Payer: Cigna of CA PPO |
$629.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$723.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: InnovAge PACE Commercial |
$425.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.70
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Riverside University Health System MISP |
$340.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.35
|
| Rate for Payer: Vantage Medical Group Senior |
$723.35
|
|
|
HC ADAPTOR MED ACCESS 6984M
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
|
HC ADAPTOR MED KIT BLV-BIS-10
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,187.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,661.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,466.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$946.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,148.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,194.51
|
| Rate for Payer: Blue Shield of California EPN |
$780.04
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.00
|
| Rate for Payer: Cigna of CA HMO |
$1,251.20
|
| Rate for Payer: Cigna of CA PPO |
$1,446.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,661.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,661.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,661.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.00
|
| Rate for Payer: EPIC Health Plan Senior |
$782.00
|
| Rate for Payer: Galaxy Health WC |
$1,661.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,759.50
|
| Rate for Payer: InnovAge PACE Commercial |
$977.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,368.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,368.50
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: Networks By Design Commercial |
$1,270.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,661.75
|
| Rate for Payer: Riverside University Health System MISP |
$782.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,173.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other HMO |
$977.50
|
| Rate for Payer: United Healthcare HMO Rider |
$977.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$977.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,661.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,661.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,661.75
|
|
|
HC ADAPTOR MED KIT BLV-BIS-10
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.00
|
| Rate for Payer: EPIC Health Plan Senior |
$782.00
|
| Rate for Payer: Galaxy Health WC |
$1,661.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,759.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: Networks By Design Commercial |
$1,270.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,661.75
|
|
|
HC ADC LLUH CURR/FORMER EMP RATE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000003
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC ADC LLUH CURR/FORMER EMP RATE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000003
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC ADC W ADDL SERVICE
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000015
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$134.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$118.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.79
|
| Rate for Payer: Blue Shield of California Commercial |
$96.54
|
| Rate for Payer: Blue Shield of California EPN |
$63.04
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$134.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Senior |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: InnovAge PACE Commercial |
$79.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Riverside University Health System MISP |
$63.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$134.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.30
|
| Rate for Payer: Vantage Medical Group Senior |
$134.30
|
|
|
HC ADC W ADDL SERVICE
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000015
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Senior |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
915352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.82
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.00
|
| Rate for Payer: InnovAge PACE Commercial |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
915352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
905352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
905352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.82
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.00
|
| Rate for Payer: InnovAge PACE Commercial |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
IP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
915355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,815.40 |
| Max. Negotiated Rate |
$8,169.30 |
| Rate for Payer: Adventist Health Commercial |
$1,815.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,016.52
|
| Rate for Payer: Blue Shield of California EPN |
$4,574.81
|
| Rate for Payer: Cash Price |
$4,992.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,261.60
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,169.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,458.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.40
|
| Rate for Payer: Multiplan Commercial |
$6,807.75
|
| Rate for Payer: Networks By Design Commercial |
$5,900.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
OP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
905355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,941.69 |
| Max. Negotiated Rate |
$8,169.30 |
| Rate for Payer: Adventist Health Commercial |
$3,721.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,992.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,807.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,330.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,016.52
|
| Rate for Payer: Blue Shield of California EPN |
$4,574.81
|
| Rate for Payer: Cash Price |
$4,992.35
|
| Rate for Payer: Cash Price |
$4,992.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,261.60
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,715.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,715.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,169.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,941.69
|
| Rate for Payer: InnovAge PACE Commercial |
$4,538.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,144.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,721.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,353.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,353.90
|
| Rate for Payer: Multiplan Commercial |
$6,807.75
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,630.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,446.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,446.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,715.45
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
IP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
905355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,815.40 |
| Max. Negotiated Rate |
$8,169.30 |
| Rate for Payer: Adventist Health Commercial |
$1,815.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,016.52
|
| Rate for Payer: Blue Shield of California EPN |
$4,574.81
|
| Rate for Payer: Cash Price |
$4,992.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,261.60
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,169.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,458.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.40
|
| Rate for Payer: Multiplan Commercial |
$6,807.75
|
| Rate for Payer: Networks By Design Commercial |
$5,900.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
|
