|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| 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 |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: InnovAge PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| 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 |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| 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 |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: InnovAge PACE Commercial |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| 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 |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| 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 |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: InnovAge PACE Commercial |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| 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 |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| 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 |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: InnovAge PACE Commercial |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| 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 |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
OP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
915357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,333.76 |
| Max. Negotiated Rate |
$6,413.40 |
| Rate for Payer: Adventist Health Commercial |
$2,921.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,919.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,185.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,591.50
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.80
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,057.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,057.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,413.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3,563.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,921.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,988.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,988.20
|
| Rate for Payer: Multiplan Commercial |
$5,344.50
|
| Rate for Payer: Networks By Design Commercial |
$3,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,850.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,057.10
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
IP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
915357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.20 |
| Max. Negotiated Rate |
$6,413.40 |
| Rate for Payer: Adventist Health Commercial |
$1,425.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,591.50
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.80
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,413.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.20
|
| Rate for Payer: Multiplan Commercial |
$5,344.50
|
| Rate for Payer: Networks By Design Commercial |
$4,631.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
IP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
905357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.20 |
| Max. Negotiated Rate |
$6,413.40 |
| Rate for Payer: Adventist Health Commercial |
$1,425.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,591.50
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.80
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,413.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.20
|
| Rate for Payer: Multiplan Commercial |
$5,344.50
|
| Rate for Payer: Networks By Design Commercial |
$4,631.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
|
|
HC ELECT WRIST ROTAT OTTO BOCK OR
|
Facility
|
OP
|
$7,126.00
|
|
|
Service Code
|
CPT L7260
|
| Hospital Charge Code |
905357260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,333.76 |
| Max. Negotiated Rate |
$6,413.40 |
| Rate for Payer: Adventist Health Commercial |
$2,921.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,919.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,185.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,591.50
|
| Rate for Payer: Cash Price |
$3,206.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.80
|
| Rate for Payer: Cigna of CA HMO |
$4,988.20
|
| Rate for Payer: Cigna of CA PPO |
$4,988.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,057.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,057.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.40
|
| Rate for Payer: Galaxy Health WC |
$6,057.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,413.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3,563.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,715.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,921.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,988.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,988.20
|
| Rate for Payer: Multiplan Commercial |
$5,344.50
|
| Rate for Payer: Networks By Design Commercial |
$3,563.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,850.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,674.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2,603.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,546.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,333.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,057.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,057.10
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,546.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,169.07 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,547.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,476.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,219.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,911.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
915357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,169.07 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,547.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,476.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,219.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,911.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
915357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,546.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$8,923.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,030.70 |
| Rate for Payer: Adventist Health Commercial |
$1,784.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,138.40
|
| Rate for Payer: Cigna of CA HMO |
$5,710.72
|
| Rate for Payer: Cigna of CA PPO |
$6,603.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$7,584.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,353.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,030.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,692.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$5,799.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,584.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,353.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,461.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$8,923.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,784.60 |
| Max. Negotiated Rate |
$8,030.70 |
| Rate for Payer: Adventist Health Commercial |
$1,784.60
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,138.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,569.20
|
| Rate for Payer: Galaxy Health WC |
$7,584.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,353.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,030.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,399.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,523.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.60
|
| Rate for Payer: Multiplan Commercial |
$6,692.25
|
| Rate for Payer: Networks By Design Commercial |
$5,799.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,584.55
|
|
|
HC EMBOLIC ONYX
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,638.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,024.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,800.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,144.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
|
|
HC EMBOLIC ONYX
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,500.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,739.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,322.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,638.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,024.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,800.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,100.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,400.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,144.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Blue Shield of California Commercial |
$276.73
|
| Rate for Payer: Blue Shield of California EPN |
$180.43
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Central Health Plan Commercial |
$286.40
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.36
|
| Rate for Payer: United Healthcare All Other HMO |
$130.78
|
| Rate for Payer: United Healthcare HMO Rider |
$127.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.22
|
| Rate for Payer: Blue Shield of California Commercial |
$276.73
|
| Rate for Payer: Blue Shield of California EPN |
$180.43
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Central Health Plan Commercial |
$286.40
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.20
|
| Rate for Payer: InnovAge PACE Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Riverside University Health System MISP |
$143.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.36
|
| Rate for Payer: United Healthcare All Other HMO |
$130.78
|
| Rate for Payer: United Healthcare HMO Rider |
$127.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,182.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,682.50
|
| Rate for Payer: Blue Shield of California Commercial |
$15,275.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,975.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,000.00
|
| Rate for Payer: Cigna of CA PPO |
$18,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Central Health Plan Commercial |
$27,509.60
|
| Rate for Payer: Cigna of CA HMO |
$22,007.68
|
| Rate for Payer: Cigna of CA PPO |
$25,446.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$29,228.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,632.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,948.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,936.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,877.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$22,351.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$29,228.95
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,632.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
