|
HC INDR COOK ANSEL #1 FLEXOR 9FR
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
|
|
HC INDR COOK ANSEL #1 FLEXOR 9FR
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.41
|
| Rate for Payer: Blue Shield of California Commercial |
$230.35
|
| Rate for Payer: Blue Shield of California EPN |
$150.42
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: Cigna of CA HMO |
$241.28
|
| Rate for Payer: Cigna of CA PPO |
$278.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: InnovAge PACE Commercial |
$188.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
| Rate for Payer: Riverside University Health System MISP |
$150.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.50
|
| Rate for Payer: United Healthcare All Other HMO |
$188.50
|
| Rate for Payer: United Healthcare HMO Rider |
$188.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.45
|
| Rate for Payer: Vantage Medical Group Senior |
$320.45
|
|
|
HC INDR COOK FLEXOR SHUTTLE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC INDR COOK FLEXOR SHUTTLE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC INDR COOK KELLER-TIMMERMAN
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$309.20
|
| Rate for Payer: Cash Price |
$695.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,236.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$618.40
|
| Rate for Payer: Galaxy Health WC |
$1,314.10
|
| Rate for Payer: Global Benefits Group Commercial |
$927.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,391.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$1,004.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
|
|
HC INDR COOK KELLER-TIMMERMAN
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$309.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$938.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$850.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,159.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$748.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.97
|
| Rate for Payer: Blue Shield of California Commercial |
$944.61
|
| Rate for Payer: Blue Shield of California EPN |
$616.85
|
| Rate for Payer: Cash Price |
$695.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,236.80
|
| Rate for Payer: Cigna of CA HMO |
$989.44
|
| Rate for Payer: Cigna of CA PPO |
$1,144.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,314.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,314.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$618.40
|
| Rate for Payer: Galaxy Health WC |
$1,314.10
|
| Rate for Payer: Global Benefits Group Commercial |
$927.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,391.40
|
| Rate for Payer: InnovAge PACE Commercial |
$773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,082.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,082.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$1,004.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
| Rate for Payer: Riverside University Health System MISP |
$618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$927.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$927.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$773.00
|
| Rate for Payer: United Healthcare HMO Rider |
$773.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,314.10
|
|
|
HC INDR COOK MICROPUNCTURE STIFF
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC INDR COOK MICROPUNCTURE STIFF
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC INDR COOK MICRPUNCTURE
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.76
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$101.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Central Health Plan Commercial |
$204.00
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Senior |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.50
|
| Rate for Payer: InnovAge PACE Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Riverside University Health System MISP |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other HMO |
$127.50
|
| Rate for Payer: United Healthcare HMO Rider |
$127.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC INDR COOK MICRPUNCTURE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Central Health Plan Commercial |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Senior |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
IP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$332.77 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Central Health Plan Commercial |
$295.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.95
|
| Rate for Payer: Multiplan Commercial |
$277.31
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
|
OP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$332.77 |
| Rate for Payer: Adventist Health Commercial |
$73.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$224.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.15
|
| Rate for Payer: Blue Shield of California Commercial |
$225.92
|
| Rate for Payer: Blue Shield of California EPN |
$147.53
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Central Health Plan Commercial |
$295.80
|
| Rate for Payer: Cigna of CA HMO |
$236.64
|
| Rate for Payer: Cigna of CA PPO |
$273.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Senior |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.77
|
| Rate for Payer: InnovAge PACE Commercial |
$184.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$258.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$258.82
|
| Rate for Payer: Multiplan Commercial |
$277.31
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
| Rate for Payer: Riverside University Health System MISP |
$147.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.88
|
| Rate for Payer: United Healthcare All Other HMO |
$184.88
|
| Rate for Payer: United Healthcare HMO Rider |
$184.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.29
|
| Rate for Payer: Vantage Medical Group Senior |
$314.29
|
|
|
HC INDR COOK PERFORMER
|
Facility
|
OP
|
$596.85
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$537.16 |
| Rate for Payer: Adventist Health Commercial |
$119.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$507.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$447.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.53
|
| Rate for Payer: Blue Shield of California Commercial |
$364.68
|
| Rate for Payer: Blue Shield of California EPN |
$238.14
|
| Rate for Payer: Cash Price |
$268.58
|
| Rate for Payer: Central Health Plan Commercial |
$477.48
|
| Rate for Payer: Cigna of CA HMO |
$381.98
|
| Rate for Payer: Cigna of CA PPO |
$441.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.74
|
| Rate for Payer: EPIC Health Plan Senior |
$238.74
|
| Rate for Payer: Galaxy Health WC |
$507.32
|
| Rate for Payer: Global Benefits Group Commercial |
$358.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.16
|
| Rate for Payer: InnovAge PACE Commercial |
$298.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$417.80
|
| Rate for Payer: Multiplan Commercial |
$447.64
|
| Rate for Payer: Networks By Design Commercial |
$387.95
|
| Rate for Payer: Prime Health Services Commercial |
$507.32
|
| Rate for Payer: Riverside University Health System MISP |
$238.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.43
|
| Rate for Payer: United Healthcare All Other HMO |
$298.43
|
| Rate for Payer: United Healthcare HMO Rider |
$298.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.32
|
| Rate for Payer: Vantage Medical Group Senior |
$507.32
|
|
|
HC INDR COOK PERFORMER
|
Facility
|
IP
|
$596.85
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$537.16 |
| Rate for Payer: Adventist Health Commercial |
$119.37
|
| Rate for Payer: Cash Price |
$268.58
|
| Rate for Payer: Central Health Plan Commercial |
$477.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.74
|
| Rate for Payer: EPIC Health Plan Senior |
$238.74
|
| Rate for Payer: Galaxy Health WC |
$507.32
|
| Rate for Payer: Global Benefits Group Commercial |
$358.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.37
|
| Rate for Payer: Multiplan Commercial |
$447.64
|
| Rate for Payer: Networks By Design Commercial |
$387.95
|
| Rate for Payer: Prime Health Services Commercial |
$507.32
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR CORDIS VISTA BRITE TIP
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR CORDIS VISTA BRITE TIP
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR FUSION OASIS 9FRX195CM STENT ONE ACTION STERILE
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
900100313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.16
|
| Rate for Payer: Blue Shield of California Commercial |
$281.06
|
| Rate for Payer: Blue Shield of California EPN |
$183.54
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: InnovAge PACE Commercial |
$230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Riverside University Health System MISP |
$184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC INDR FUSION OASIS 9FRX195CM STENT ONE ACTION STERILE
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
900100313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC INDR GORE DRYSEAL
|
Facility
|
IP
|
$4,062.50
|
|
| Hospital Charge Code |
906812454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.50 |
| Max. Negotiated Rate |
$3,656.25 |
| Rate for Payer: Adventist Health Commercial |
$812.50
|
| Rate for Payer: Cash Price |
$1,828.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,625.00
|
| Rate for Payer: Galaxy Health WC |
$3,453.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,656.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.50
|
| Rate for Payer: Multiplan Commercial |
$3,046.88
|
| Rate for Payer: Networks By Design Commercial |
$2,640.62
|
| Rate for Payer: Prime Health Services Commercial |
$3,453.12
|
|
|
HC INDR GORE DRYSEAL
|
Facility
|
OP
|
$4,062.50
|
|
| Hospital Charge Code |
906812454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.50 |
| Max. Negotiated Rate |
$3,656.25 |
| Rate for Payer: Adventist Health Commercial |
$812.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,467.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,453.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,234.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,046.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,967.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,385.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,482.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,620.94
|
| Rate for Payer: Cash Price |
$1,828.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,250.00
|
| Rate for Payer: Cigna of CA HMO |
$2,600.00
|
| Rate for Payer: Cigna of CA PPO |
$3,006.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,453.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,453.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,453.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,625.00
|
| Rate for Payer: Galaxy Health WC |
$3,453.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2,437.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,656.25
|
| Rate for Payer: InnovAge PACE Commercial |
$2,031.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,547.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,514.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,843.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,843.75
|
| Rate for Payer: Multiplan Commercial |
$3,046.88
|
| Rate for Payer: Networks By Design Commercial |
$2,640.62
|
| Rate for Payer: Prime Health Services Commercial |
$3,453.12
|
| Rate for Payer: Riverside University Health System MISP |
$1,625.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,437.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,031.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2,031.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,031.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,031.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,453.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,453.12
|
| Rate for Payer: Vantage Medical Group Senior |
$3,453.12
|
|
|
HC INDR HOWELL 10FRX200CM BILIARY
|
Facility
|
OP
|
$533.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.72 |
| Max. Negotiated Rate |
$480.24 |
| Rate for Payer: Adventist Health Commercial |
$106.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$258.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.38
|
| Rate for Payer: Blue Shield of California Commercial |
$326.03
|
| Rate for Payer: Blue Shield of California EPN |
$212.91
|
| Rate for Payer: Cash Price |
$240.12
|
| Rate for Payer: Central Health Plan Commercial |
$426.88
|
| Rate for Payer: Cigna of CA HMO |
$341.50
|
| Rate for Payer: Cigna of CA PPO |
$394.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.44
|
| Rate for Payer: EPIC Health Plan Senior |
$213.44
|
| Rate for Payer: Galaxy Health WC |
$453.56
|
| Rate for Payer: Global Benefits Group Commercial |
$320.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$480.24
|
| Rate for Payer: InnovAge PACE Commercial |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$355.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$330.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$373.52
|
| Rate for Payer: Multiplan Commercial |
$400.20
|
| Rate for Payer: Networks By Design Commercial |
$346.84
|
| Rate for Payer: Prime Health Services Commercial |
$453.56
|
| Rate for Payer: Riverside University Health System MISP |
$213.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$320.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$320.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.80
|
| Rate for Payer: United Healthcare All Other HMO |
$266.80
|
| Rate for Payer: United Healthcare HMO Rider |
$266.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.56
|
| Rate for Payer: Vantage Medical Group Senior |
$453.56
|
|
|
HC INDR HOWELL 10FRX200CM BILIARY
|
Facility
|
IP
|
$533.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.72 |
| Max. Negotiated Rate |
$480.24 |
| Rate for Payer: Adventist Health Commercial |
$106.72
|
| Rate for Payer: Cash Price |
$240.12
|
| Rate for Payer: Central Health Plan Commercial |
$426.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.44
|
| Rate for Payer: EPIC Health Plan Senior |
$213.44
|
| Rate for Payer: Galaxy Health WC |
$453.56
|
| Rate for Payer: Global Benefits Group Commercial |
$320.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$355.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$330.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$400.20
|
| Rate for Payer: Networks By Design Commercial |
$346.84
|
| Rate for Payer: Prime Health Services Commercial |
$453.56
|
|
|
HC INDR MED FLEXCATH STEERABLE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1766
|
| Hospital Charge Code |
906812545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
