|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Blue Shield of California EPN |
$141.51
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.06
|
| Rate for Payer: United Healthcare All Other HMO |
$97.73
|
| Rate for Payer: United Healthcare HMO Rider |
$95.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.45
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,365.97
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$974.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.90
|
| Rate for Payer: United Healthcare All Other HMO |
$943.39
|
| Rate for Payer: United Healthcare HMO Rider |
$922.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$844.14
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$895.30 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,406.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,238.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.27
|
| Rate for Payer: Blue Distinction Transplant |
$1,534.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,918.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.55
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Media |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,918.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$895.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.78
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,023.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,279.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,279.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,279.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,279.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,162.35 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,826.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,608.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,962.05
|
| Rate for Payer: Blue Distinction Transplant |
$1,992.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,490.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,806.62
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Media |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,490.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,162.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.61
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,660.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,660.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,660.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,773.41
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.20
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,254.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,224.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,198.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,095.93
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
OP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
905351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,038.45 |
| Max. Negotiated Rate |
$2,670.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,631.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,631.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,436.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,752.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,780.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,225.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,614.05
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,373.60
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Dignity Health Media |
$2,521.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,521.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,670.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,225.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,038.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,216.47
|
| Rate for Payer: Multiplan Commercial |
$2,225.25
|
| Rate for Payer: Networks By Design Commercial |
$1,483.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,483.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,483.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,483.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,483.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,521.95
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
IP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
905351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$2,670.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,584.38
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,373.60
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,670.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$2,225.25
|
| Rate for Payer: Networks By Design Commercial |
$1,483.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,120.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,094.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1,070.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.11
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$625.50 |
| 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 |
$382.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.61
|
| Rate for Payer: Blue Distinction Transplant |
$417.00
|
| Rate for Payer: Blue Shield of California Commercial |
$521.25
|
| Rate for Payer: Blue Shield of California EPN |
$378.08
|
| 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 Media |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$521.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.25
|
| 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: LLUH Dept of Risk Management WC |
$284.95
|
| 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 |
$347.50
|
| Rate for Payer: United Healthcare All Other HMO |
$347.50
|
| Rate for Payer: United Healthcare HMO Rider |
$347.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$347.50
|
| 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: Blue Shield of California EPN |
$371.13
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$139.00
|
| 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: United Healthcare All Other Commercial |
$262.43
|
| Rate for Payer: United Healthcare All Other HMO |
$256.32
|
| Rate for Payer: United Healthcare HMO Rider |
$250.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.35
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
905351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$248.40 |
| 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 |
$151.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.06
|
| Rate for Payer: Blue Distinction Transplant |
$165.60
|
| Rate for Payer: Blue Shield of California Commercial |
$207.00
|
| Rate for Payer: Blue Shield of California EPN |
$150.14
|
| 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 Media |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$207.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.60
|
| 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: LLUH Dept of Risk Management WC |
$113.16
|
| 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 |
$138.00
|
| Rate for Payer: United Healthcare All Other HMO |
$138.00
|
| Rate for Payer: United Healthcare HMO Rider |
$138.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.00
|
| 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: Blue Shield of California EPN |
$147.38
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$55.20
|
| 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: United Healthcare All Other Commercial |
$104.22
|
| Rate for Payer: United Healthcare All Other HMO |
$101.79
|
| Rate for Payer: United Healthcare HMO Rider |
$99.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.08
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
905351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$174.60 |
| 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 |
$106.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.62
|
| Rate for Payer: Blue Distinction Transplant |
$116.40
|
| Rate for Payer: Blue Shield of California Commercial |
$145.50
|
| Rate for Payer: Blue Shield of California EPN |
$105.54
|
| 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 Media |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$145.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.90
|
| 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: LLUH Dept of Risk Management WC |
$79.54
|
| 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 |
$97.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
| 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
|
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: Blue Shield of California EPN |
$103.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$38.80
|
| 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: United Healthcare All Other Commercial |
$73.25
|
| Rate for Payer: United Healthcare All Other HMO |
$71.55
|
| Rate for Payer: United Healthcare HMO Rider |
$70.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.02
|
|
|
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: Blue Shield of California EPN |
$299.04
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$112.00
|
| 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: United Healthcare All Other Commercial |
$211.46
|
| Rate for Payer: United Healthcare All Other HMO |
$206.53
|
| Rate for Payer: United Healthcare HMO Rider |
$202.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.80
|
|
|
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 |
$196.00 |
| Max. Negotiated Rate |
$504.00 |
| 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 |
$308.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$271.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.85
|
| Rate for Payer: Blue Distinction Transplant |
$336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$420.00
|
| Rate for Payer: Blue Shield of California EPN |
$304.64
|
| 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 Media |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$420.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$196.00
|
| 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: LLUH Dept of Risk Management WC |
$229.60
|
| 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 |
$280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.00
|
| 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
|
IP
|
$18.78
|
|
| Hospital Charge Code |
901602021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$16.90 |
| 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: 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: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$14.08
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
|
|
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: 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 |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.10
|
| Rate for Payer: Blue Distinction Transplant |
$11.27
|
| Rate for Payer: Blue Shield of California Commercial |
$11.81
|
| Rate for Payer: Blue Shield of California EPN |
$9.18
|
| 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 Media |
$15.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$14.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.57
|
| 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: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$14.08
|
| 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 Medi-Cal |
$15.96
|
| Rate for Payer: Vantage Medical Group Senior |
$15.96
|
|
|
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: 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: 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: 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 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: 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 |
$10.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.48
|
| Rate for Payer: Blue Distinction Transplant |
$11.66
|
| Rate for Payer: Blue Shield of California Commercial |
$12.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.50
|
| 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 Media |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.80
|
| 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: 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
|
| 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 |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC HOLDER ET TUBE 3.0MM
|
Facility
|
OP
|
$72.73
|
|
| Hospital Charge Code |
901605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$65.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.97
|
| Rate for Payer: Blue Distinction Transplant |
$43.64
|
| Rate for Payer: Blue Shield of California Commercial |
$45.75
|
| Rate for Payer: Blue Shield of California EPN |
$35.56
|
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Central Health Plan Commercial |
$58.18
|
| Rate for Payer: Cigna of CA HMO |
$46.55
|
| Rate for Payer: Cigna of CA PPO |
$53.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.82
|
| Rate for Payer: Dignity Health Media |
$61.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.09
|
| Rate for Payer: Galaxy Health WC |
$61.82
|
| Rate for Payer: Global Benefits Group Commercial |
$43.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$54.55
|
| Rate for Payer: Networks By Design Commercial |
$47.27
|
| Rate for Payer: Prime Health Services Commercial |
$61.82
|
| Rate for Payer: Riverside University Health System MISP |
$29.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.36
|
| Rate for Payer: United Healthcare All Other HMO |
$36.36
|
| Rate for Payer: United Healthcare HMO Rider |
$36.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.82
|
| Rate for Payer: Vantage Medical Group Senior |
$61.82
|
|
|
HC HOLDER ET TUBE 3.0MM
|
Facility
|
IP
|
$72.73
|
|
| Hospital Charge Code |
901605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$65.46 |
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Central Health Plan Commercial |
$58.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.09
|
| Rate for Payer: Galaxy Health WC |
$61.82
|
| Rate for Payer: Global Benefits Group Commercial |
$43.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$54.55
|
| Rate for Payer: Networks By Design Commercial |
$47.27
|
| Rate for Payer: Prime Health Services Commercial |
$61.82
|
|
|
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: 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: 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: 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 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: 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 |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.34
|
| Rate for Payer: Blue Distinction Transplant |
$14.56
|
| Rate for Payer: Blue Shield of California Commercial |
$15.27
|
| Rate for Payer: Blue Shield of California EPN |
$11.87
|
| 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 Media |
$20.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$18.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.49
|
| 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: 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
|
| 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 |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.63
|
| Rate for Payer: Vantage Medical Group Senior |
$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: 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: 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: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC HOLDER E.T. TUBE 4.0MM
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901602018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.55
|
| Rate for Payer: Blue Distinction Transplant |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Media |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.92
|
| 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: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
