|
HC COOK COIL EXPANDER
|
Facility
|
IP
|
$441.00
|
|
| Hospital Charge Code |
906812710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC COOK CRUVED FEMORAL SHEATH SET
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC COOK CRUVED FEMORAL SHEATH SET
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.30
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC COOK CURVED INNER FEMORAL SHEATH
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$572.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$456.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$553.82
|
| Rate for Payer: Blue Shield of California Commercial |
$576.17
|
| Rate for Payer: Blue Shield of California EPN |
$376.26
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$801.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: InnovAge PACE Commercial |
$471.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.10
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Riverside University Health System MISP |
$377.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.50
|
| Rate for Payer: United Healthcare All Other HMO |
$471.50
|
| Rate for Payer: United Healthcare HMO Rider |
$471.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
|
HC COOK CURVED INNER FEMORAL SHEATH
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC COOK EVOLUTION RL SHEATH SET
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COOK EVOLUTION RL SHEATH SET
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK INDR PEEL AWAY CURVED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC COOK INDR PEEL AWAY CURVED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC COOK LIBERATOR BEACON TIP STYLET
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.30
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC COOK LIBERATOR BEACON TIP STYLET
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC COOK NEEDLE EYE SNARE ONLY
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
|
|
HC COOK NEEDLE EYE SNARE ONLY
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,705.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,544.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,106.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,359.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,649.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,120.39
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$1,797.12
|
| Rate for Payer: Cigna of CA PPO |
$2,077.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,386.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,386.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,965.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,123.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,684.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,684.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,386.80
|
|
|
HC COOK NEEDLE EYE SNARE SET
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COOK NEEDLE EYE SNARE SET
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK ONE-TIE COMPRESSION COIL
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
906812713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$781.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$505.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$539.73
|
| Rate for Payer: Blue Shield of California Commercial |
$561.51
|
| Rate for Payer: Blue Shield of California EPN |
$366.68
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: Cigna of CA HMO |
$588.16
|
| Rate for Payer: Cigna of CA PPO |
$680.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$781.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$781.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: InnovAge PACE Commercial |
$459.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$568.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.30
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
| Rate for Payer: Riverside University Health System MISP |
$367.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$551.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$551.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$459.50
|
| Rate for Payer: United Healthcare All Other HMO |
$459.50
|
| Rate for Payer: United Healthcare HMO Rider |
$459.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$459.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$781.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.15
|
| Rate for Payer: Vantage Medical Group Senior |
$781.15
|
|
|
HC COOK ONE-TIE COMPRESSION COIL
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
906812713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$568.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
|
|
HC COOK SHORTIE RL ENTRY SHEATH
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COOK SHORTIE RL ENTRY SHEATH
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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 COOK SOF-GRIP HEMOSTAT
|
Facility
|
IP
|
$429.00
|
|
| Hospital Charge Code |
906812709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Central Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: Networks By Design Commercial |
$278.85
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
|
|
HC COOK SOF-GRIP HEMOSTAT
|
Facility
|
OP
|
$429.00
|
|
| Hospital Charge Code |
906812709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.95
|
| Rate for Payer: Blue Shield of California Commercial |
$262.12
|
| Rate for Payer: Blue Shield of California EPN |
$171.17
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Central Health Plan Commercial |
$343.20
|
| Rate for Payer: Cigna of CA HMO |
$274.56
|
| Rate for Payer: Cigna of CA PPO |
$317.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.10
|
| Rate for Payer: InnovAge PACE Commercial |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$300.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: Networks By Design Commercial |
$278.85
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: Riverside University Health System MISP |
$171.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.50
|
| Rate for Payer: United Healthcare All Other HMO |
$214.50
|
| Rate for Payer: United Healthcare HMO Rider |
$214.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC COOK STEADYSHEATH EVOLUTION RL
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,068.30 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$720.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,008.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$652.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$890.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$574.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.13
|
| Rate for Payer: Blue Shield of California Commercial |
$725.26
|
| Rate for Payer: Blue Shield of California EPN |
$473.61
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Central Health Plan Commercial |
$949.60
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,008.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,008.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,068.30
|
| Rate for Payer: InnovAge PACE Commercial |
$593.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$830.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$830.90
|
| Rate for Payer: Multiplan Commercial |
$890.25
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Riverside University Health System MISP |
$474.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$593.50
|
| Rate for Payer: United Healthcare All Other HMO |
$593.50
|
| Rate for Payer: United Healthcare HMO Rider |
$593.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$593.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,008.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,008.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.95
|
|
|
HC COOK STEADYSHEATH EVOLUTION RL
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,068.30 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Central Health Plan Commercial |
$949.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,068.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.40
|
| Rate for Payer: Multiplan Commercial |
$890.25
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC COOK STEADYSHEATH SHORTIE RL
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$960.30 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Central Health Plan Commercial |
$853.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$960.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.40
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC COOK STEADYSHEATH SHORTIE RL
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$960.30 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$647.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$906.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$586.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$800.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$626.65
|
| Rate for Payer: Blue Shield of California Commercial |
$651.94
|
| Rate for Payer: Blue Shield of California EPN |
$425.73
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Central Health Plan Commercial |
$853.60
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$906.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$906.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$906.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$960.30
|
| Rate for Payer: InnovAge PACE Commercial |
$533.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$746.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$746.90
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Riverside University Health System MISP |
$426.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.50
|
| Rate for Payer: United Healthcare All Other HMO |
$533.50
|
| Rate for Payer: United Healthcare HMO Rider |
$533.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$906.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$906.95
|
| Rate for Payer: Vantage Medical Group Senior |
$906.95
|
|
