|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.63
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$3.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$2.73
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.13
|
| Rate for Payer: United Healthcare All Other HMO |
$2.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Vantage Medical Group Senior |
$3.63
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
915350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
915350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.09
|
| Rate for Payer: Blue Shield of California Commercial |
$103.32
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.09
|
| Rate for Payer: Blue Shield of California Commercial |
$103.32
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
905352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
905352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
915352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
915352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cigna of CA HMO |
$247.68
|
| Rate for Payer: Cigna of CA PPO |
$286.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$451.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$239.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$270.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$270.90
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$328.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.95
|
| Rate for Payer: Vantage Medical Group Senior |
$328.95
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$239.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
915350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$603.50 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.23
|
| Rate for Payer: Blue Shield of California Commercial |
$523.98
|
| Rate for Payer: Blue Shield of California EPN |
$345.06
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$434.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
915350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
905350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
905350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$603.50 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.23
|
| Rate for Payer: Blue Shield of California Commercial |
$523.98
|
| Rate for Payer: Blue Shield of California EPN |
$345.06
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$434.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
915350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
OP
|
$9,608.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
905350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$8,166.80 |
| Rate for Payer: Adventist Health Commercial |
$3,939.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,284.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,206.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,564.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,090.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,669.49
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Cigna of CA HMO |
$6,725.60
|
| Rate for Payer: Cigna of CA PPO |
$6,725.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,166.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,166.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,843.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,843.20
|
| Rate for Payer: Galaxy Health WC |
$8,166.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,408.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,947.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,305.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,725.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,725.60
|
| Rate for Payer: Multiplan Commercial |
$7,686.40
|
| Rate for Payer: Networks By Design Commercial |
$4,804.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,764.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,764.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,605.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,509.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3,433.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,146.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,166.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,166.80
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
915350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.05
|
| Rate for Payer: Blue Shield of California Commercial |
$140.22
|
| Rate for Payer: Blue Shield of California EPN |
$92.34
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
IP
|
$9,608.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
905350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,921.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,921.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Cigna of CA HMO |
$6,725.60
|
| Rate for Payer: Cigna of CA PPO |
$6,725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,843.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,843.20
|
| Rate for Payer: Galaxy Health WC |
$8,166.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,408.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,660.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,947.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,305.92
|
| Rate for Payer: Multiplan Commercial |
$7,686.40
|
| Rate for Payer: Networks By Design Commercial |
$4,804.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,605.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,509.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3,433.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,146.62
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$254.72
|
| Rate for Payer: Cigna of CA PPO |
$294.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.65
|
| Rate for Payer: Blue Shield of California Commercial |
$346.54
|
| Rate for Payer: Blue Shield of California EPN |
$228.96
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
