|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.61 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.45
|
| Rate for Payer: InnovAge PACE Commercial |
$347.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Riverside University Health System MISP |
$278.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
915351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.61 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.45
|
| Rate for Payer: InnovAge PACE Commercial |
$347.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Riverside University Health System MISP |
$278.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
915351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
905351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$113.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.09
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.73
|
| Rate for Payer: InnovAge PACE Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Riverside University Health System MISP |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
905351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
915351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
915351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$113.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.09
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.73
|
| Rate for Payer: InnovAge PACE Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Riverside University Health System MISP |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
905351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
915351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
905351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$97.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Riverside University Health System MISP |
$77.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
915351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$97.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Riverside University Health System MISP |
$77.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
905351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
915351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.89
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$385.42
|
| Rate for Payer: InnovAge PACE Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
915351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
905351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.89
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$385.42
|
| Rate for Payer: InnovAge PACE Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC HOLDER E.T. TUBE 2.5MM
|
Facility
|
OP
|
$18.78
|
|
| Hospital Charge Code |
901602021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.03
|
| Rate for Payer: Blue Shield of California Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California EPN |
$7.49
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.02
|
| Rate for Payer: Cigna of CA HMO |
$12.02
|
| Rate for Payer: Cigna of CA PPO |
$13.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.90
|
| Rate for Payer: InnovAge PACE Commercial |
$9.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$14.09
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
| Rate for Payer: Riverside University Health System MISP |
$7.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Other HMO |
$9.39
|
| Rate for Payer: United Healthcare HMO Rider |
$9.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.96
|
| Rate for Payer: Vantage Medical Group Senior |
$15.96
|
|
|
HC HOLDER E.T. TUBE 2.5MM
|
Facility
|
IP
|
$18.78
|
|
| Hospital Charge Code |
901602021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$14.09
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
|
|
HC HOLDER E.T. TUBE 3.0MM
|
Facility
|
OP
|
$19.43
|
|
| Hospital Charge Code |
901602020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.75
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Central Health Plan Commercial |
$15.54
|
| Rate for Payer: Cigna of CA HMO |
$12.44
|
| Rate for Payer: Cigna of CA PPO |
$14.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.49
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
| Rate for Payer: Riverside University Health System MISP |
$7.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO |
$9.71
|
| Rate for Payer: United Healthcare HMO Rider |
$9.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC HOLDER E.T. TUBE 3.0MM
|
Facility
|
IP
|
$19.43
|
|
| Hospital Charge Code |
901602020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Central Health Plan Commercial |
$15.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
|
|
HC HOLDER ET TUBE 3.0MM
|
Facility
|
IP
|
$62.98
|
|
| Hospital Charge Code |
901605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$56.68 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Central Health Plan Commercial |
$50.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: EPIC Health Plan Senior |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$47.23
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
|
|
HC HOLDER ET TUBE 3.0MM
|
Facility
|
OP
|
$62.98
|
|
| Hospital Charge Code |
901605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$56.68 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.99
|
| Rate for Payer: Blue Shield of California Commercial |
$38.48
|
| Rate for Payer: Blue Shield of California EPN |
$25.13
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Central Health Plan Commercial |
$50.38
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: EPIC Health Plan Senior |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.68
|
| Rate for Payer: InnovAge PACE Commercial |
$31.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$47.23
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
| Rate for Payer: Riverside University Health System MISP |
$25.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.49
|
| Rate for Payer: United Healthcare All Other HMO |
$31.49
|
| Rate for Payer: United Healthcare HMO Rider |
$31.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.53
|
| Rate for Payer: Vantage Medical Group Senior |
$53.53
|
|
|
HC HOLDER E.T. TUBE 3.5MM
|
Facility
|
OP
|
$24.27
|
|
| Hospital Charge Code |
901602019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$21.84 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.25
|
| Rate for Payer: Blue Shield of California Commercial |
$14.83
|
| Rate for Payer: Blue Shield of California EPN |
$9.68
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Central Health Plan Commercial |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$15.53
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.63
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.84
|
| Rate for Payer: InnovAge PACE Commercial |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.63
|
| Rate for Payer: Riverside University Health System MISP |
$9.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO |
$12.13
|
| Rate for Payer: United Healthcare HMO Rider |
$12.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.63
|
| Rate for Payer: Vantage Medical Group Senior |
$20.63
|
|
|
HC HOLDER E.T. TUBE 3.5MM
|
Facility
|
IP
|
$24.27
|
|
| Hospital Charge Code |
901602019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$21.84 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Central Health Plan Commercial |
$19.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.63
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.63
|
|
|
HC HOLDER E.T. TUBE 4.0MM
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901602018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
