|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$1,065.18 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$662.20
|
| Rate for Payer: Blue Shield of California Commercial |
$841.29
|
| Rate for Payer: Blue Shield of California Commercial |
$554.66
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
915350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
905350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,539.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.00
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: Networks By Design Commercial |
$1,576.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
915350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,539.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.00
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: Networks By Design Commercial |
$1,576.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
905350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$582.00 |
| Max. Negotiated Rate |
$2,061.25 |
| Rate for Payer: Adventist Health Commercial |
$994.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,467.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,864.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,229.47
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,061.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,061.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,060.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,539.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,697.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,697.50
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,061.25
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
915350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$582.00 |
| Max. Negotiated Rate |
$2,061.25 |
| Rate for Payer: Adventist Health Commercial |
$994.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,467.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,864.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,229.47
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,061.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,061.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,060.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,539.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,697.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,697.50
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,061.25
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$203.52
|
| Rate for Payer: Cigna of CA PPO |
$235.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$398.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.65
|
| Rate for Payer: Blue Shield of California Commercial |
$284.18
|
| Rate for Payer: Blue Shield of California Commercial |
$430.65
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| 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: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$914.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.40
|
| Rate for Payer: EPIC Health Plan Senior |
$522.40
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$829.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$770.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.68
|
| Rate for Payer: Blue Shield of California Commercial |
$549.83
|
| Rate for Payer: Blue Shield of California Commercial |
$833.23
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cigna of CA HMO |
$835.84
|
| Rate for Payer: Cigna of CA PPO |
$966.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$914.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$829.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC TOBRAMYCIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC TOBRAMYCIN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.36
|
| Rate for Payer: Blue Shield of California Commercial |
$22.59
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$34.15
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.61
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO |
$13.07
|
| Rate for Payer: United Healthcare HMO Rider |
$13.07
|
| Rate for Payer: United Healthcare HMO Rider |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
|
|
HC TOES
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.59
|
| Rate for Payer: Blue Shield of California Commercial |
$218.92
|
| Rate for Payer: Blue Shield of California Commercial |
$331.76
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$332.80
|
| Rate for Payer: Cigna of CA PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| 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 |
$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: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC TOES
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
915353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.11
|
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.11
|
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
915353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$618.80 |
| Rate for Payer: EPIC Health Plan Senior |
$291.20
|
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$509.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: Galaxy Health WC |
$618.80
|
| Rate for Payer: Global Benefits Group Commercial |
$436.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$462.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.72
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Networks By Design Commercial |
$473.20
|
| Rate for Payer: Prime Health Services Commercial |
$618.80
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$618.80 |
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$618.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.13
|
| Rate for Payer: Blue Shield of California Commercial |
$306.49
|
| Rate for Payer: Blue Shield of California Commercial |
$464.46
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna of CA HMO |
$465.92
|
| Rate for Payer: Cigna of CA PPO |
$538.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$618.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$618.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$509.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: EPIC Health Plan Senior |
$291.20
|
| Rate for Payer: Galaxy Health WC |
$618.80
|
| Rate for Payer: Global Benefits Group Commercial |
$436.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$462.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Networks By Design Commercial |
$473.20
|
| Rate for Payer: Prime Health Services Commercial |
$618.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$436.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$618.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$618.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.80
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.20 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.40
|
| Rate for Payer: EPIC Health Plan Senior |
$300.40
|
| Rate for Payer: Galaxy Health WC |
$638.35
|
| Rate for Payer: Global Benefits Group Commercial |
$450.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$443.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.24
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Networks By Design Commercial |
$488.15
|
| Rate for Payer: Prime Health Services Commercial |
$638.35
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$545.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.35
|
| Rate for Payer: Blue Shield of California Commercial |
$316.17
|
| Rate for Payer: Blue Shield of California Commercial |
$479.14
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cigna of CA HMO |
$480.64
|
| Rate for Payer: Cigna of CA PPO |
$555.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$638.35
|
| Rate for Payer: Global Benefits Group Commercial |
$450.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Networks By Design Commercial |
$488.15
|
| Rate for Payer: Prime Health Services Commercial |
$638.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
905352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.09
|
| Rate for Payer: Blue Shield of California Commercial |
$186.87
|
| Rate for Payer: Blue Shield of California Commercial |
$123.20
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
