|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
OP
|
$24,631.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,926.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Cigna of CA HMO |
$16,010.15
|
| Rate for Payer: Cigna of CA PPO |
$18,226.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$20,936.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,778.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,882.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,128.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,911.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$19,704.80
|
| Rate for Payer: Networks By Design Commercial |
$16,010.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,936.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,778.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
IP
|
$24,631.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,926.20 |
| Max. Negotiated Rate |
$20,936.35 |
| Rate for Payer: Adventist Health Commercial |
$4,926.20
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,852.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,852.40
|
| Rate for Payer: Galaxy Health WC |
$20,936.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,778.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,384.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,246.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,911.44
|
| Rate for Payer: Multiplan Commercial |
$19,704.80
|
| Rate for Payer: Networks By Design Commercial |
$16,010.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,936.35
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
OP
|
$23,939.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906820065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,787.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$10,772.55
|
| Rate for Payer: Cash Price |
$10,772.55
|
| Rate for Payer: Cash Price |
$10,772.55
|
| Rate for Payer: Cigna of CA HMO |
$15,560.35
|
| Rate for Payer: Cigna of CA PPO |
$17,714.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$20,348.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14,363.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,882.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,967.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,128.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$19,151.20
|
| Rate for Payer: Networks By Design Commercial |
$15,560.35
|
| Rate for Payer: Prime Health Services Commercial |
$20,348.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,363.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$16,725.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906820066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$7,526.25
|
| Rate for Payer: Cash Price |
$7,526.25
|
| Rate for Payer: Cash Price |
$7,526.25
|
| Rate for Payer: Cigna of CA HMO |
$10,871.25
|
| Rate for Payer: Cigna of CA PPO |
$12,376.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$14,216.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,035.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,159.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,155.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,442.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,014.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$13,380.00
|
| Rate for Payer: Networks By Design Commercial |
$10,871.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,216.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$17,208.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,441.60 |
| Max. Negotiated Rate |
$14,626.80 |
| Rate for Payer: Adventist Health Commercial |
$3,441.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,883.20
|
| Rate for Payer: Galaxy Health WC |
$14,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,324.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,477.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,556.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,651.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,129.92
|
| Rate for Payer: Multiplan Commercial |
$13,766.40
|
| Rate for Payer: Networks By Design Commercial |
$11,185.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,626.80
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$17,208.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,441.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cigna of CA HMO |
$11,185.20
|
| Rate for Payer: Cigna of CA PPO |
$12,733.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$14,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,324.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,159.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,477.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,442.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,129.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$13,766.40
|
| Rate for Payer: Networks By Design Commercial |
$11,185.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,324.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$16,725.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906820066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,345.00 |
| Max. Negotiated Rate |
$14,216.25 |
| Rate for Payer: Adventist Health Commercial |
$3,345.00
|
| Rate for Payer: Cash Price |
$7,526.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,690.00
|
| Rate for Payer: Galaxy Health WC |
$14,216.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,155.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,372.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,352.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,014.00
|
| Rate for Payer: Multiplan Commercial |
$13,380.00
|
| Rate for Payer: Networks By Design Commercial |
$10,871.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,216.25
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
OP
|
$15,902.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,677.38 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,180.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: Cigna of CA HMO |
$10,336.30
|
| Rate for Payer: Cigna of CA PPO |
$11,767.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$13,516.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,677.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,606.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,816.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$12,721.60
|
| Rate for Payer: Networks By Design Commercial |
$10,336.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,516.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
IP
|
$15,455.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906820088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,091.00 |
| Max. Negotiated Rate |
$13,136.75 |
| Rate for Payer: Adventist Health Commercial |
$3,091.00
|
| Rate for Payer: Cash Price |
$6,954.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,182.00
|
| Rate for Payer: Galaxy Health WC |
$13,136.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,308.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,888.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,566.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,709.20
|
| Rate for Payer: Multiplan Commercial |
$12,364.00
|
| Rate for Payer: Networks By Design Commercial |
$10,045.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,136.75
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
OP
|
$15,455.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906820088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,677.38 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,091.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$6,954.75
|
| Rate for Payer: Cash Price |
$6,954.75
|
| Rate for Payer: Cash Price |
$6,954.75
|
| Rate for Payer: Cigna of CA HMO |
$10,045.75
|
| Rate for Payer: Cigna of CA PPO |
$11,436.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$13,136.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,273.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,677.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,308.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,709.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$12,364.00
|
| Rate for Payer: Networks By Design Commercial |
$10,045.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,136.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
IP
|
$15,902.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,180.40 |
| Max. Negotiated Rate |
$13,516.70 |
| Rate for Payer: Adventist Health Commercial |
$3,180.40
|
| Rate for Payer: Cash Price |
$7,155.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,360.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,360.80
|
| Rate for Payer: Galaxy Health WC |
$13,516.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,541.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,606.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,058.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,843.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,816.48
|
| Rate for Payer: Multiplan Commercial |
$12,721.60
|
| Rate for Payer: Networks By Design Commercial |
$10,336.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,516.70
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$55.19 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.19
|
| Rate for Payer: Blue Shield of California Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California EPN |
$25.64
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.65
|
| Rate for Payer: EPIC Health Plan Senior |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$184.45 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Blue Shield of California Commercial |
$160.15
|
| Rate for Payer: Blue Shield of California EPN |
$105.46
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$151.90
|
| Rate for Payer: Cigna of CA PPO |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$108.50
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.01
|
| Rate for Payer: Blue Shield of California Commercial |
$99.40
|
| Rate for Payer: Blue Shield of California EPN |
$99.40
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$151.90
|
| Rate for Payer: Cigna of CA PPO |
$151.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$108.50
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.01
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$282.88
|
| Rate for Payer: Cigna of CA PPO |
$327.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$221.00
|
| Rate for Payer: United Healthcare HMO Rider |
$221.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
915350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
915350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC RIB BELT CUSTOM FITTED
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
905350210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$109.20
|
| Rate for Payer: Cigna of CA PPO |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.99
|
| Rate for Payer: United Healthcare HMO Rider |
$55.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.09
|
|
|
HC RIB BELT CUSTOM FITTED
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
905350210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.36
|
| Rate for Payer: Blue Shield of California Commercial |
$115.13
|
| Rate for Payer: Blue Shield of California EPN |
$75.82
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$109.20
|
| Rate for Payer: Cigna of CA PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.99
|
| Rate for Payer: United Healthcare HMO Rider |
$55.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
