|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.22
|
| Rate for Payer: Blue Distinction Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$390.00
|
| Rate for Payer: Blue Shield of California EPN |
$282.88
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Media |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$390.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$260.00
|
| Rate for Payer: United Healthcare HMO Rider |
$260.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Blue Shield of California EPN |
$277.68
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.60
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.47
|
| Rate for Payer: Blue Distinction Transplant |
$138.60
|
| Rate for Payer: Blue Shield of California Commercial |
$173.25
|
| Rate for Payer: Blue Shield of California EPN |
$125.66
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Media |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$173.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.71
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Riverside University Health System MISP |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Blue Shield of California EPN |
$123.35
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.23
|
| Rate for Payer: United Healthcare All Other HMO |
$85.19
|
| Rate for Payer: United Healthcare HMO Rider |
$83.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.23
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$331.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.11
|
| Rate for Payer: Blue Distinction Transplant |
$410.40
|
| Rate for Payer: Blue Shield of California Commercial |
$513.00
|
| Rate for Payer: Blue Shield of California EPN |
$372.10
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Media |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$513.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.44
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Riverside University Health System MISP |
$273.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$342.00
|
| Rate for Payer: United Healthcare All Other HMO |
$342.00
|
| Rate for Payer: United Healthcare HMO Rider |
$342.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$342.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Blue Shield of California EPN |
$365.26
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.28
|
| Rate for Payer: United Healthcare All Other HMO |
$252.26
|
| Rate for Payer: United Healthcare HMO Rider |
$246.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.72
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.89
|
| Rate for Payer: Blue Distinction Transplant |
$85.20
|
| Rate for Payer: Blue Shield of California Commercial |
$106.50
|
| Rate for Payer: Blue Shield of California EPN |
$77.25
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Media |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$106.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Riverside University Health System MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71.00
|
| Rate for Payer: United Healthcare HMO Rider |
$71.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Blue Shield of California EPN |
$75.83
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.62
|
| Rate for Payer: United Healthcare All Other HMO |
$52.37
|
| Rate for Payer: United Healthcare HMO Rider |
$51.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.86
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$119.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.12
|
| Rate for Payer: Blue Distinction Transplant |
$31.80
|
| Rate for Payer: Blue Shield of California Commercial |
$32.75
|
| Rate for Payer: Blue Shield of California EPN |
$25.76
|
| Rate for Payer: Caremore Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.60
|
| Rate for Payer: Dignity Health Media |
$13.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: InnovAge PACE Commercial |
$20.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
IP
|
$6,484.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,296.80 |
| Max. Negotiated Rate |
$5,835.60 |
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,593.60
|
| Rate for Payer: Galaxy Health WC |
$5,511.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,890.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,835.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,470.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.80
|
| Rate for Payer: Multiplan Commercial |
$4,863.00
|
| Rate for Payer: Networks By Design Commercial |
$4,214.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,511.40
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$6,484.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$10,254.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$634.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,511.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,566.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,566.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,890.40
|
| 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 |
$2,917.80
|
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,187.20
|
| Rate for Payer: Cigna of CA PPO |
$4,798.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,511.40
|
| Rate for Payer: Dignity Health Media |
$5,511.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,511.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,593.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,593.60
|
| Rate for Payer: Galaxy Health WC |
$5,511.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,890.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,835.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,863.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,470.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.80
|
| Rate for Payer: Multiplan Commercial |
$4,863.00
|
| Rate for Payer: Networks By Design Commercial |
$4,214.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,511.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,593.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,511.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,511.40
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906820016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.80 |
| Max. Negotiated Rate |
$1,151.10 |
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,151.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.80
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906820016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.80 |
| Max. Negotiated Rate |
$3,519.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,884.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$703.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$703.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,885.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,519.46
|
| Rate for Payer: Blue Distinction Transplant |
$767.40
|
| Rate for Payer: Blue Shield of California Commercial |
$790.42
|
| Rate for Payer: Blue Shield of California EPN |
$621.59
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,023.20
|
| Rate for Payer: Cigna of CA HMO |
$818.56
|
| Rate for Payer: Cigna of CA PPO |
$946.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Dignity Health Media |
$1,087.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,087.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,151.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$959.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$447.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.80
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
| Rate for Payer: Riverside University Health System MISP |
$511.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$767.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.50
|
| Rate for Payer: United Healthcare All Other HMO |
$639.50
|
| Rate for Payer: United Healthcare HMO Rider |
$639.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$639.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,087.15
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.80 |
| Max. Negotiated Rate |
$3,519.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,884.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$703.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$703.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,885.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,519.46
|
| Rate for Payer: Blue Distinction Transplant |
$767.40
|
| Rate for Payer: Blue Shield of California Commercial |
$790.42
|
| Rate for Payer: Blue Shield of California EPN |
$621.59
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,023.20
|
| Rate for Payer: Cigna of CA HMO |
$818.56
|
| Rate for Payer: Cigna of CA PPO |
$946.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Dignity Health Media |
$1,087.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,087.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,151.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$959.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$447.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.80
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
| Rate for Payer: Riverside University Health System MISP |
$511.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$767.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.50
|
| Rate for Payer: United Healthcare All Other HMO |
$639.50
|
| Rate for Payer: United Healthcare HMO Rider |
$639.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$639.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,087.15
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.80 |
| Max. Negotiated Rate |
$1,151.10 |
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,151.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.80
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906820017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$3,015.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,613.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$602.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,471.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,015.20
|
| Rate for Payer: Blue Distinction Transplant |
$657.60
|
| Rate for Payer: Blue Shield of California Commercial |
$677.33
|
| Rate for Payer: Blue Shield of California EPN |
$532.66
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Media |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Riverside University Health System MISP |
$438.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906820017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$3,015.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,613.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$602.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,471.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,015.20
|
| Rate for Payer: Blue Distinction Transplant |
$657.60
|
| Rate for Payer: Blue Shield of California Commercial |
$677.33
|
| Rate for Payer: Blue Shield of California EPN |
$532.66
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Media |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Riverside University Health System MISP |
$438.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Blue Shield of California Commercial |
$210.00
|
| Rate for Payer: Blue Shield of California EPN |
$149.52
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.42
|
| Rate for Payer: Blue Distinction Transplant |
$168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$176.12
|
| Rate for Payer: Blue Shield of California EPN |
$136.92
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Media |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.00
|
| Rate for Payer: Blue Distinction Transplant |
$168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$176.12
|
| Rate for Payer: Blue Shield of California EPN |
$136.92
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Media |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT A4649
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
OP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.33
|
| Rate for Payer: Blue Distinction Transplant |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$81.27
|
| Rate for Payer: Blue Shield of California EPN |
$63.18
|
| Rate for Payer: Cash Price |
$58.14
|
| Rate for Payer: Central Health Plan Commercial |
$103.36
|
| Rate for Payer: Cigna of CA HMO |
$82.69
|
| Rate for Payer: Cigna of CA PPO |
$95.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.82
|
| Rate for Payer: Dignity Health Media |
$109.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Multiplan Commercial |
$96.90
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
| Rate for Payer: Riverside University Health System MISP |
$51.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other HMO |
$64.60
|
| Rate for Payer: United Healthcare HMO Rider |
$64.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.82
|
| Rate for Payer: Vantage Medical Group Senior |
$109.82
|
|
