|
HC SHOE TRNSFR CALIPER PLATE EXIS
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT L3600
|
| Hospital Charge Code |
905353600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Blue Shield of California EPN |
$68.35
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC SHOE TRNSFR CALIPER PLATE EXIS
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT L3600
|
| Hospital Charge Code |
905353600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$302.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.62
|
| Rate for Payer: BCBS Transplant Transplant |
$76.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California EPN |
$69.63
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.00
|
| Rate for Payer: IEHP medi-cal |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.48
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$64.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC SHOE TRNSFR DB SPLINT BOTH SHO
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT L3640
|
| Hospital Charge Code |
905353640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$171.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$171.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.17
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.96
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: IEHP medi-cal |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.90
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC SHOE TRNSFR DB SPLINT BOTH SHO
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT L3640
|
| Hospital Charge Code |
905353640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Blue Shield of California EPN |
$48.06
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC SHOE TRNSFR NEW CALIPER
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT L3610
|
| Hospital Charge Code |
905353610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Blue Shield of California EPN |
$106.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SHOE TRNSFR NEW CALIPER
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT L3610
|
| Hospital Charge Code |
905353610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$398.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.16
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$150.00
|
| Rate for Payer: Blue Shield of California EPN |
$108.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: IEHP medi-cal |
$70.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Riverside University Health MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SHOE TRNSFR NEW SOLID STIRRUP
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT L3630
|
| Hospital Charge Code |
905353630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Blue Shield of California EPN |
$106.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SHOE TRNSFR NEW SOLID STIRRUP
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT L3630
|
| Hospital Charge Code |
905353630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$398.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.16
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$150.00
|
| Rate for Payer: Blue Shield of California EPN |
$108.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: IEHP medi-cal |
$70.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Riverside University Health MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SHOE TRNSFR SOLID STIRRUP EXIS
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT L3620
|
| Hospital Charge Code |
905353620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Blue Shield of California EPN |
$80.10
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SHOE TRNSFR SOLID STIRRUP EXIS
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT L3620
|
| Hospital Charge Code |
905353620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$302.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.62
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.50
|
| Rate for Payer: Blue Shield of California EPN |
$81.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: IEHP medi-cal |
$52.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$542.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$350.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$350.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$542.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$478.50
|
| Rate for Payer: IEHP medi-cal |
$223.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$382.80
|
| Rate for Payer: Riverside University Health MISP |
$255.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Vantage Medical Group Senior |
$542.30
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
OP
|
$1,039.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$935.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.81
|
| Rate for Payer: BCBS Transplant Transplant |
$623.40
|
| Rate for Payer: Blue Shield of California Commercial |
$642.10
|
| Rate for Payer: Blue Shield of California EPN |
$504.95
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$467.55
|
| Rate for Payer: Cash Price |
$467.55
|
| Rate for Payer: Central Health Plan Commercial |
$831.20
|
| Rate for Payer: Cigna of CA HMO |
$664.96
|
| Rate for Payer: Cigna of CA PPO |
$768.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$883.15
|
| Rate for Payer: Global Benefits Group Commercial |
$623.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$935.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$779.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$779.25
|
| Rate for Payer: Networks By Design Commercial |
$675.35
|
| Rate for Payer: Prime Health Services Commercial |
$883.15
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$623.40
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$623.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$623.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
IP
|
$1,039.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.80 |
| Max. Negotiated Rate |
$935.10 |
| Rate for Payer: Cash Price |
$467.55
|
| Rate for Payer: Central Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.60
|
| Rate for Payer: Galaxy Health WC |
$883.15
|
| Rate for Payer: Global Benefits Group Commercial |
$623.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$935.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.80
|
| Rate for Payer: Multiplan Commercial |
$779.25
|
| Rate for Payer: Networks By Design Commercial |
$675.35
|
| Rate for Payer: Prime Health Services Commercial |
$883.15
|
|
|
HC SHOULDER LIMITED
|
Facility
OP
|
$876.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.20
|
| Rate for Payer: BCBS Transplant Transplant |
$525.60
|
| Rate for Payer: Blue Shield of California Commercial |
$541.37
|
| Rate for Payer: Blue Shield of California EPN |
$425.74
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Central Health Plan Commercial |
$700.80
|
| Rate for Payer: Cigna of CA HMO |
$560.64
|
| Rate for Payer: Cigna of CA PPO |
$648.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$744.60
|
| Rate for Payer: Global Benefits Group Commercial |
$525.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$788.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$657.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$657.00
|
| Rate for Payer: Networks By Design Commercial |
$569.40
|
| Rate for Payer: Prime Health Services Commercial |
$744.60
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$525.60
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SHOULDER LIMITED
|
Facility
IP
|
$876.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Central Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.40
|
| Rate for Payer: Galaxy Health WC |
$744.60
|
| Rate for Payer: Global Benefits Group Commercial |
$525.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$788.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$657.00
|
| Rate for Payer: Networks By Design Commercial |
$569.40
|
| Rate for Payer: Prime Health Services Commercial |
$744.60
|
|
|
HC SHOWER SHIELD 10X12IN
|
Facility
OP
|
$8.20
|
|
| Hospital Charge Code |
901698410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.84
|
| Rate for Payer: BCBS Transplant Transplant |
$4.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Central Health Plan Commercial |
$6.56
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.28
|
| Rate for Payer: Galaxy Health WC |
$6.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.15
|
| Rate for Payer: IEHP medi-cal |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$6.15
|
| Rate for Payer: Networks By Design Commercial |
$5.33
|
| Rate for Payer: Prime Health Services Commercial |
$6.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.92
|
| Rate for Payer: Riverside University Health MISP |
$3.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: Vantage Medical Group Senior |
$6.97
|
|
|
HC SHOWER SHIELD 10X12IN
|
Facility
IP
|
$8.20
|
|
| Hospital Charge Code |
901698410
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Central Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: Galaxy Health WC |
$6.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$6.15
|
| Rate for Payer: Networks By Design Commercial |
$5.33
|
| Rate for Payer: Prime Health Services Commercial |
$6.97
|
|
|
HC SHOWER SHIELD 7X7IN
|
Facility
IP
|
$13.94
|
|
| Hospital Charge Code |
901698408
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: Networks By Design Commercial |
$9.06
|
| Rate for Payer: Prime Health Services Commercial |
$11.85
|
|
|
HC SHOWER SHIELD 7X7IN
|
Facility
OP
|
$13.94
|
|
| Hospital Charge Code |
901698408
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.24
|
| Rate for Payer: BCBS Transplant Transplant |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.82
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.15
|
| Rate for Payer: Cigna of CA HMO |
$8.92
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.46
|
| Rate for Payer: IEHP medi-cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: Networks By Design Commercial |
$9.06
|
| Rate for Payer: Prime Health Services Commercial |
$11.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: Riverside University Health MISP |
$5.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.85
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC SHOWER SHIELD 9X9IN
|
Facility
IP
|
$7.38
|
|
| Hospital Charge Code |
901698409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
|
HC SHOWER SHIELD 9X9IN
|
Facility
OP
|
$7.38
|
|
| Hospital Charge Code |
901698409
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.36
|
| Rate for Payer: BCBS Transplant Transplant |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.54
|
| Rate for Payer: IEHP medi-cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: Riverside University Health MISP |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.27
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
IP
|
$214.13
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.83 |
| Max. Negotiated Rate |
$192.72 |
| Rate for Payer: Cash Price |
$96.36
|
| Rate for Payer: Central Health Plan Commercial |
$171.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.65
|
| Rate for Payer: Galaxy Health WC |
$182.01
|
| Rate for Payer: Global Benefits Group Commercial |
$128.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.83
|
| Rate for Payer: Multiplan Commercial |
$160.60
|
| Rate for Payer: Networks By Design Commercial |
$139.18
|
| Rate for Payer: Prime Health Services Commercial |
$182.01
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
OP
|
$214.13
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.83 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$117.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$117.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.51
|
| Rate for Payer: BCBS Transplant Transplant |
$128.48
|
| Rate for Payer: Blue Shield of California Commercial |
$134.69
|
| Rate for Payer: Blue Shield of California EPN |
$104.71
|
| Rate for Payer: Cash Price |
$96.36
|
| Rate for Payer: Cash Price |
$96.36
|
| Rate for Payer: Central Health Plan Commercial |
$171.30
|
| Rate for Payer: Cigna of CA HMO |
$137.04
|
| Rate for Payer: Cigna of CA PPO |
$158.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$182.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.65
|
| Rate for Payer: Galaxy Health WC |
$182.01
|
| Rate for Payer: Global Benefits Group Commercial |
$128.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$160.60
|
| Rate for Payer: IEHP medi-cal |
$74.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.83
|
| Rate for Payer: Multiplan Commercial |
$160.60
|
| Rate for Payer: Networks By Design Commercial |
$139.18
|
| Rate for Payer: Prime Health Services Commercial |
$182.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$128.48
|
| Rate for Payer: Riverside University Health MISP |
$85.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.06
|
| Rate for Payer: United Healthcare All Other HMO |
$107.06
|
| Rate for Payer: United Healthcare HMO Rider |
$107.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.01
|
| Rate for Payer: Vantage Medical Group Senior |
$182.01
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
OP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$118.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$118.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.25
|
| Rate for Payer: BCBS Transplant Transplant |
$129.23
|
| Rate for Payer: Blue Shield of California Commercial |
$135.48
|
| Rate for Payer: Blue Shield of California EPN |
$105.33
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Central Health Plan Commercial |
$172.31
|
| Rate for Payer: Cigna of CA HMO |
$137.85
|
| Rate for Payer: Cigna of CA PPO |
$159.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$161.54
|
| Rate for Payer: IEHP medi-cal |
$75.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.08
|
| Rate for Payer: Multiplan Commercial |
$161.54
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$129.23
|
| Rate for Payer: Riverside University Health MISP |
$86.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.70
|
| Rate for Payer: United Healthcare All Other HMO |
$107.70
|
| Rate for Payer: United Healthcare HMO Rider |
$107.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.08
|
| Rate for Payer: Vantage Medical Group Senior |
$183.08
|
|
