|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$64,324.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,643.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Cigna of CA HMO |
$41,167.36
|
| Rate for Payer: Cigna of CA PPO |
$47,599.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,349.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$11,282.14
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,707.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$64,324.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,864.80 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25,729.60
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,951.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
OP
|
$64,324.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Cigna of CA HMO |
$41,167.36
|
| Rate for Payer: Cigna of CA PPO |
$47,599.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,349.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
IP
|
$64,324.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,864.80 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25,729.60
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,951.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
OP
|
$64,324.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Cigna of CA HMO |
$41,167.36
|
| Rate for Payer: Cigna of CA PPO |
$47,599.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,349.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$962.00 |
| Max. Negotiated Rate |
$4,329.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,367.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,924.00
|
| Rate for Payer: Galaxy Health WC |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,054.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,837.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: Cigna of CA HMO |
$3,078.40
|
| Rate for Payer: Cigna of CA PPO |
$3,559.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,367.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,054.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,746.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,886.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$64,324.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,864.80 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25,729.60
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,951.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$64,324.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$40,371.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$64,907.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Cigna of CA HMO |
$41,167.36
|
| Rate for Payer: Cigna of CA PPO |
$47,599.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,612.68
|
| Rate for Payer: EPIC Health Plan Senior |
$44,408.45
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$66,208.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,349.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,519.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Preferred Health Network WC |
$66,232.50
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$42,793.60
|
| Rate for Payer: Prime Health Services WC |
$64,245.53
|
| Rate for Payer: Riverside University Health System MISP |
$44,408.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,371.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Blue Shield of California Commercial |
$399.42
|
| Rate for Payer: Blue Shield of California Commercial |
$85.68
|
| Rate for Payer: Blue Shield of California EPN |
$251.70
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Blue Shield of California Commercial |
$399.42
|
| Rate for Payer: Blue Shield of California Commercial |
$85.68
|
| Rate for Payer: Blue Shield of California EPN |
$251.70
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC SUMP TUBE VALVE ANTI REFLUX
|
Facility
|
OP
|
$43.05
|
|
| Hospital Charge Code |
901698825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Adventist Health Commercial |
$8.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Blue Shield of California EPN |
$17.18
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Central Health Plan Commercial |
$34.44
|
| Rate for Payer: Cigna of CA HMO |
$27.55
|
| Rate for Payer: Cigna of CA PPO |
$31.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.22
|
| Rate for Payer: EPIC Health Plan Senior |
$17.22
|
| Rate for Payer: Galaxy Health WC |
$36.59
|
| Rate for Payer: Global Benefits Group Commercial |
$25.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.14
|
| Rate for Payer: Multiplan Commercial |
$32.29
|
| Rate for Payer: Networks By Design Commercial |
$27.98
|
| Rate for Payer: Prime Health Services Commercial |
$36.59
|
| Rate for Payer: Riverside University Health System MISP |
$17.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.52
|
| Rate for Payer: United Healthcare HMO Rider |
$21.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.59
|
| Rate for Payer: Vantage Medical Group Senior |
$36.59
|
|
|
HC SUMP TUBE VALVE ANTI REFLUX
|
Facility
|
IP
|
$43.05
|
|
| Hospital Charge Code |
901698825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Adventist Health Commercial |
$8.61
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Central Health Plan Commercial |
$34.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.22
|
| Rate for Payer: EPIC Health Plan Senior |
$17.22
|
| Rate for Payer: Galaxy Health WC |
$36.59
|
| Rate for Payer: Global Benefits Group Commercial |
$25.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$32.29
|
| Rate for Payer: Networks By Design Commercial |
$27.98
|
| Rate for Payer: Prime Health Services Commercial |
$36.59
|
|
|
HC SUPPORT BACK CRISS-CROSS 2XL
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Adventist Health Commercial |
$34.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.25
|
| Rate for Payer: Blue Shield of California Commercial |
$67.90
|
| Rate for Payer: Blue Shield of California EPN |
$42.67
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Central Health Plan Commercial |
$67.73
|
| Rate for Payer: Cigna of CA HMO |
$59.26
|
| Rate for Payer: Cigna of CA PPO |
$59.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.86
|
| Rate for Payer: EPIC Health Plan Senior |
$33.86
|
| Rate for Payer: Galaxy Health WC |
$71.96
|
| Rate for Payer: Global Benefits Group Commercial |
$50.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.26
|
| Rate for Payer: Multiplan Commercial |
$63.49
|
| Rate for Payer: Networks By Design Commercial |
$42.33
|
| Rate for Payer: Prime Health Services Commercial |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$33.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$30.93
|
| Rate for Payer: United Healthcare HMO Rider |
$30.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.96
|
| Rate for Payer: Vantage Medical Group Senior |
$71.96
|
|
|
HC SUPPORT BACK CRISS-CROSS 2XL
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Adventist Health Commercial |
$16.93
|
| Rate for Payer: Blue Shield of California Commercial |
$67.90
|
| Rate for Payer: Blue Shield of California EPN |
$42.67
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Central Health Plan Commercial |
$67.73
|
| Rate for Payer: Cigna of CA HMO |
$59.26
|
| Rate for Payer: Cigna of CA PPO |
$59.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.86
|
| Rate for Payer: EPIC Health Plan Senior |
$33.86
|
| Rate for Payer: Galaxy Health WC |
$71.96
|
| Rate for Payer: Global Benefits Group Commercial |
$50.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$63.49
|
| Rate for Payer: Networks By Design Commercial |
$55.03
|
| Rate for Payer: Prime Health Services Commercial |
$71.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.77
|
| Rate for Payer: United Healthcare All Other HMO |
$30.93
|
| Rate for Payer: United Healthcare HMO Rider |
$30.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.73
|
|
|
HC SUPPORT BACK CRISS-CROSS LRG
|
Facility
|
OP
|
$128.59
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.11 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Adventist Health Commercial |
$52.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.13
|
| Rate for Payer: Blue Shield of California EPN |
$64.81
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$90.01
|
| Rate for Payer: Cigna of CA PPO |
$90.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Senior |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.01
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$64.30
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: Riverside University Health System MISP |
$51.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.26
|
| Rate for Payer: United Healthcare All Other HMO |
$46.97
|
| Rate for Payer: United Healthcare HMO Rider |
$45.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.30
|
| Rate for Payer: Vantage Medical Group Senior |
$109.30
|
|
|
HC SUPPORT BACK CRISS-CROSS LRG
|
Facility
|
IP
|
$128.59
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Adventist Health Commercial |
$25.72
|
| Rate for Payer: Blue Shield of California Commercial |
$103.13
|
| Rate for Payer: Blue Shield of California EPN |
$64.81
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$90.01
|
| Rate for Payer: Cigna of CA PPO |
$90.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Senior |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.72
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$83.58
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.26
|
| Rate for Payer: United Healthcare All Other HMO |
$46.97
|
| Rate for Payer: United Healthcare HMO Rider |
$45.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.11
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Blue Shield of California Commercial |
$212.88
|
| Rate for Payer: Blue Shield of California EPN |
$133.78
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
|
|
HC SUPPORT BACK CRISS-CROSS MED
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901607799
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$108.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.41
|
| Rate for Payer: Blue Shield of California Commercial |
$212.88
|
| Rate for Payer: Blue Shield of California EPN |
$133.78
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$185.81
|
| Rate for Payer: Cigna of CA PPO |
$185.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$132.72
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Riverside University Health System MISP |
$106.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.62
|
| Rate for Payer: United Healthcare All Other HMO |
$96.97
|
| Rate for Payer: United Healthcare HMO Rider |
$94.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
|
IP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$90.29 |
| Rate for Payer: Adventist Health Commercial |
$20.06
|
| Rate for Payer: Blue Shield of California Commercial |
$80.46
|
| Rate for Payer: Blue Shield of California EPN |
$50.56
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Central Health Plan Commercial |
$80.26
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Senior |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$75.24
|
| Rate for Payer: Networks By Design Commercial |
$65.21
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.65
|
| Rate for Payer: United Healthcare All Other HMO |
$36.65
|
| Rate for Payer: United Healthcare HMO Rider |
$35.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.85
|
|
|
HC SUPPORT BACK ELASTIC XL
|
Facility
|
OP
|
$100.32
|
|
|
Service Code
|
CPT L0456
|
| Hospital Charge Code |
901607781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$1,187.90 |
| Rate for Payer: Adventist Health Commercial |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.36
|
| Rate for Payer: Blue Shield of California Commercial |
$80.46
|
| Rate for Payer: Blue Shield of California EPN |
$50.56
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Cash Price |
$45.14
|
| Rate for Payer: Central Health Plan Commercial |
$80.26
|
| Rate for Payer: Cigna of CA HMO |
$70.22
|
| Rate for Payer: Cigna of CA PPO |
$70.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.13
|
| Rate for Payer: EPIC Health Plan Senior |
$40.13
|
| Rate for Payer: Galaxy Health WC |
$85.27
|
| Rate for Payer: Global Benefits Group Commercial |
$60.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,075.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.22
|
| Rate for Payer: Multiplan Commercial |
$75.24
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$85.27
|
| Rate for Payer: Riverside University Health System MISP |
$40.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.65
|
| Rate for Payer: United Healthcare All Other HMO |
$36.65
|
| Rate for Payer: United Healthcare HMO Rider |
$35.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.27
|
| Rate for Payer: Vantage Medical Group Senior |
$85.27
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$313.86 |
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.12
|
| Rate for Payer: Blue Shield of California Commercial |
$118.74
|
| Rate for Payer: Blue Shield of California EPN |
$74.62
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Central Health Plan Commercial |
$118.44
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Senior |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$111.04
|
| Rate for Payer: Networks By Design Commercial |
$74.03
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: Riverside University Health System MISP |
$59.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO |
$54.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.84
|
| Rate for Payer: Vantage Medical Group Senior |
$125.84
|
|
|
HC SUPPORT ELBOW LARGE
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
901607793
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Adventist Health Commercial |
$29.61
|
| Rate for Payer: Blue Shield of California Commercial |
$118.74
|
| Rate for Payer: Blue Shield of California EPN |
$74.62
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Central Health Plan Commercial |
$118.44
|
| Rate for Payer: Cigna of CA HMO |
$103.64
|
| Rate for Payer: Cigna of CA PPO |
$103.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.22
|
| Rate for Payer: EPIC Health Plan Senior |
$59.22
|
| Rate for Payer: Galaxy Health WC |
$125.84
|
| Rate for Payer: Global Benefits Group Commercial |
$88.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.61
|
| Rate for Payer: Multiplan Commercial |
$111.04
|
| Rate for Payer: Networks By Design Commercial |
$96.23
|
| Rate for Payer: Prime Health Services Commercial |
$125.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO |
$54.08
|
| Rate for Payer: United Healthcare HMO Rider |
$52.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.49
|
|
