|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
905356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,614.90 |
| Max. Negotiated Rate |
$4,437.90 |
| Rate for Payer: Adventist Health Commercial |
$2,021.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,712.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,698.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,895.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,811.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,191.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,191.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,437.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,605.77
|
| Rate for Payer: InnovAge PACE Commercial |
$2,465.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,451.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,451.70
|
| Rate for Payer: Multiplan Commercial |
$3,698.25
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,972.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,958.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,958.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,191.35
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
905356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,284.60
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$23,674.95
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
905356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,468.10 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,391.23
|
| Rate for Payer: Blue Shield of California Commercial |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,468.10
|
| Rate for Payer: InnovAge PACE Commercial |
$18,211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Riverside University Health System MISP |
$14,569.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,468.10 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,391.23
|
| Rate for Payer: Blue Shield of California Commercial |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,468.10
|
| Rate for Payer: InnovAge PACE Commercial |
$18,211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Riverside University Health System MISP |
$14,569.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,284.60
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$23,674.95
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,715.63 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,869.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,409.72
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,258.61
|
| Rate for Payer: InnovAge PACE Commercial |
$4,146.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,399.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,804.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,715.63 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,869.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,409.72
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,258.61
|
| Rate for Payer: InnovAge PACE Commercial |
$4,146.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,399.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,804.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,409.72
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,159.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$5,389.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,409.72
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,159.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$5,389.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$791.89 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,869.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,090.78
|
| Rate for Payer: InnovAge PACE Commercial |
$1,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Riverside University Health System MISP |
$967.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,869.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,869.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$791.89 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,869.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,090.78
|
| Rate for Payer: InnovAge PACE Commercial |
$1,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Riverside University Health System MISP |
$967.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$866.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$173.20 |
| Max. Negotiated Rate |
$779.40 |
| Rate for Payer: Adventist Health Commercial |
$173.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$736.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$476.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$649.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$419.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.60
|
| Rate for Payer: Blue Shield of California Commercial |
$529.13
|
| Rate for Payer: Blue Shield of California EPN |
$345.53
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Central Health Plan Commercial |
$692.80
|
| Rate for Payer: Cigna of CA HMO |
$554.24
|
| Rate for Payer: Cigna of CA PPO |
$640.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$736.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.40
|
| Rate for Payer: EPIC Health Plan Senior |
$346.40
|
| Rate for Payer: Galaxy Health WC |
$736.10
|
| Rate for Payer: Global Benefits Group Commercial |
$519.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$779.40
|
| Rate for Payer: InnovAge PACE Commercial |
$433.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$577.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$536.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$606.20
|
| Rate for Payer: Multiplan Commercial |
$649.50
|
| Rate for Payer: Networks By Design Commercial |
$562.90
|
| Rate for Payer: Prime Health Services Commercial |
$736.10
|
| Rate for Payer: Riverside University Health System MISP |
$346.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$433.00
|
| Rate for Payer: United Healthcare All Other HMO |
$433.00
|
| Rate for Payer: United Healthcare HMO Rider |
$433.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$433.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$736.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.10
|
| Rate for Payer: Vantage Medical Group Senior |
$736.10
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$866.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$173.20 |
| Max. Negotiated Rate |
$779.40 |
| Rate for Payer: Adventist Health Commercial |
$173.20
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Central Health Plan Commercial |
$692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.40
|
| Rate for Payer: EPIC Health Plan Senior |
$346.40
|
| Rate for Payer: Galaxy Health WC |
$736.10
|
| Rate for Payer: Global Benefits Group Commercial |
$519.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$779.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$577.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$536.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.20
|
| Rate for Payer: Multiplan Commercial |
$649.50
|
| Rate for Payer: Networks By Design Commercial |
$562.90
|
| Rate for Payer: Prime Health Services Commercial |
$736.10
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,465.20 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$895.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$788.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.12
|
| Rate for Payer: Blue Shield of California Commercial |
$994.71
|
| Rate for Payer: Blue Shield of California EPN |
$649.57
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,302.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.92
|
| Rate for Payer: Cigna of CA PPO |
$1,204.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,383.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,465.20
|
| Rate for Payer: InnovAge PACE Commercial |
$814.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$620.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,139.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
| Rate for Payer: Riverside University Health System MISP |
$651.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$976.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.00
|
| Rate for Payer: United Healthcare All Other HMO |
$814.00
|
| Rate for Payer: United Healthcare HMO Rider |
$814.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$814.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,383.80
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,465.20 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,465.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$620.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
OP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,841.52 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,534.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,581.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.25
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Central Health Plan Commercial |
$1,636.90
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,841.52
|
| Rate for Payer: InnovAge PACE Commercial |
$1,023.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,364.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,266.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.29
|
| Rate for Payer: Multiplan Commercial |
$1,534.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: Riverside University Health System MISP |
$818.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,227.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,227.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.21
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
IP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,841.52 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,581.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.25
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Central Health Plan Commercial |
$1,636.90
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,841.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,364.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,266.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.23
|
| Rate for Payer: Multiplan Commercial |
$1,534.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
IP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$704.29 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Blue Shield of California Commercial |
$604.91
|
| Rate for Payer: Blue Shield of California EPN |
$394.41
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Central Health Plan Commercial |
$626.04
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.51
|
| Rate for Payer: Multiplan Commercial |
$586.91
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
OP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$704.29 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$357.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.30
|
| Rate for Payer: Blue Shield of California Commercial |
$604.91
|
| Rate for Payer: Blue Shield of California EPN |
$394.41
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Central Health Plan Commercial |
$626.04
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$665.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$665.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$665.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.29
|
| Rate for Payer: InnovAge PACE Commercial |
$391.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.78
|
| Rate for Payer: Multiplan Commercial |
$586.91
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: Riverside University Health System MISP |
$313.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$665.17
|
| Rate for Payer: Vantage Medical Group Senior |
$665.17
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
OP
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$1,214.34 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,011.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$616.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$747.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.99
|
| Rate for Payer: Blue Shield of California EPN |
$680.03
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Central Health Plan Commercial |
$1,079.42
|
| Rate for Payer: Cigna of CA HMO |
$944.49
|
| Rate for Payer: Cigna of CA PPO |
$944.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,146.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,146.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.71
|
| Rate for Payer: EPIC Health Plan Senior |
$539.71
|
| Rate for Payer: Galaxy Health WC |
$1,146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$809.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,214.34
|
| Rate for Payer: InnovAge PACE Commercial |
$674.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$944.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$944.49
|
| Rate for Payer: Multiplan Commercial |
$1,011.95
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: Riverside University Health System MISP |
$539.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$809.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.38
|
| Rate for Payer: United Healthcare All Other HMO |
$492.89
|
| Rate for Payer: United Healthcare HMO Rider |
$482.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,146.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1,146.88
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
IP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$1,042.87 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Blue Shield of California Commercial |
$895.71
|
| Rate for Payer: Blue Shield of California EPN |
$584.00
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Central Health Plan Commercial |
$926.99
|
| Rate for Payer: Cigna of CA HMO |
$811.12
|
| Rate for Payer: Cigna of CA PPO |
$811.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.50
|
| Rate for Payer: EPIC Health Plan Senior |
$463.50
|
| Rate for Payer: Galaxy Health WC |
$984.93
|
| Rate for Payer: Global Benefits Group Commercial |
$695.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$869.05
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Other HMO |
$423.29
|
| Rate for Payer: United Healthcare HMO Rider |
$414.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.49
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
IP
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$1,214.34 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.99
|
| Rate for Payer: Blue Shield of California EPN |
$680.03
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Central Health Plan Commercial |
$1,079.42
|
| Rate for Payer: Cigna of CA HMO |
$944.49
|
| Rate for Payer: Cigna of CA PPO |
$944.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.71
|
| Rate for Payer: EPIC Health Plan Senior |
$539.71
|
| Rate for Payer: Galaxy Health WC |
$1,146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$809.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,214.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.85
|
| Rate for Payer: Multiplan Commercial |
$1,011.95
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.38
|
| Rate for Payer: United Healthcare All Other HMO |
$492.89
|
| Rate for Payer: United Healthcare HMO Rider |
$482.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.89
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
OP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$1,042.87 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$637.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$869.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$529.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$641.59
|
| Rate for Payer: Blue Shield of California Commercial |
$895.71
|
| Rate for Payer: Blue Shield of California EPN |
$584.00
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Central Health Plan Commercial |
$926.99
|
| Rate for Payer: Cigna of CA HMO |
$811.12
|
| Rate for Payer: Cigna of CA PPO |
$811.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.50
|
| Rate for Payer: EPIC Health Plan Senior |
$463.50
|
| Rate for Payer: Galaxy Health WC |
$984.93
|
| Rate for Payer: Global Benefits Group Commercial |
$695.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.87
|
| Rate for Payer: InnovAge PACE Commercial |
$579.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$811.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$811.12
|
| Rate for Payer: Multiplan Commercial |
$869.05
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: Riverside University Health System MISP |
$463.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$695.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$695.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Other HMO |
$423.29
|
| Rate for Payer: United Healthcare HMO Rider |
$414.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.93
|
| Rate for Payer: Vantage Medical Group Senior |
$984.93
|
|
