|
HC TISSUE BIOSKIN WOUND MATRIX 4X4CM
|
Facility
|
IP
|
$243.75
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$219.38 |
| Rate for Payer: Adventist Health Commercial |
$48.75
|
| Rate for Payer: Blue Shield of California Commercial |
$195.49
|
| Rate for Payer: Blue Shield of California EPN |
$122.85
|
| Rate for Payer: Cash Price |
$109.69
|
| Rate for Payer: Central Health Plan Commercial |
$195.00
|
| Rate for Payer: Cigna of CA HMO |
$170.62
|
| Rate for Payer: Cigna of CA PPO |
$170.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Senior |
$97.50
|
| Rate for Payer: Galaxy Health WC |
$207.19
|
| Rate for Payer: Global Benefits Group Commercial |
$146.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$182.81
|
| Rate for Payer: Networks By Design Commercial |
$121.88
|
| Rate for Payer: Prime Health Services Commercial |
$207.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.48
|
| Rate for Payer: United Healthcare All Other HMO |
$89.04
|
| Rate for Payer: United Healthcare HMO Rider |
$87.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.83
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.01
|
| Rate for Payer: Blue Shield of California Commercial |
$79.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$6.23
|
| Rate for Payer: Prime Health Services Medicare |
$6.23
|
| Rate for Payer: Riverside University Health System MISP |
$6.47
|
| Rate for Payer: Riverside University Health System MISP |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Blue Shield of California Commercial |
$344.06
|
| Rate for Payer: Blue Shield of California EPN |
$216.22
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Central Health Plan Commercial |
$343.20
|
| Rate for Payer: Cigna of CA HMO |
$300.30
|
| Rate for Payer: Cigna of CA PPO |
$300.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$300.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$272.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.71
|
| Rate for Payer: United Healthcare HMO Rider |
$153.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.26
|
| Rate for Payer: Blue Shield of California Commercial |
$344.06
|
| Rate for Payer: Blue Shield of California EPN |
$216.22
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Central Health Plan Commercial |
$343.20
|
| Rate for Payer: Cigna of CA HMO |
$300.30
|
| Rate for Payer: Cigna of CA PPO |
$300.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$364.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$300.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$272.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: Riverside University Health System MISP |
$171.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.71
|
| Rate for Payer: United Healthcare HMO Rider |
$153.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC TISSUE MARKER 18GA
|
Facility
|
IP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,104.48 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Blue Shield of California Commercial |
$984.21
|
| Rate for Payer: Blue Shield of California EPN |
$618.51
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Central Health Plan Commercial |
$981.76
|
| Rate for Payer: Cigna of CA HMO |
$859.04
|
| Rate for Payer: Cigna of CA PPO |
$859.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$859.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.88
|
| Rate for Payer: EPIC Health Plan Senior |
$490.88
|
| Rate for Payer: Galaxy Health WC |
$1,043.12
|
| Rate for Payer: Global Benefits Group Commercial |
$736.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$779.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$724.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.44
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.57
|
| Rate for Payer: United Healthcare All Other HMO |
$448.30
|
| Rate for Payer: United Healthcare HMO Rider |
$438.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.91
|
|
|
HC TISSUE MARKER 18GA
|
Facility
|
OP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,104.48 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$674.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$920.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$560.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$673.00
|
| Rate for Payer: Blue Shield of California Commercial |
$984.21
|
| Rate for Payer: Blue Shield of California EPN |
$618.51
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Central Health Plan Commercial |
$981.76
|
| Rate for Payer: Cigna of CA HMO |
$859.04
|
| Rate for Payer: Cigna of CA PPO |
$859.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,043.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,043.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$859.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.88
|
| Rate for Payer: EPIC Health Plan Senior |
$490.88
|
| Rate for Payer: Galaxy Health WC |
$1,043.12
|
| Rate for Payer: Global Benefits Group Commercial |
$736.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$779.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$724.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$859.04
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.12
|
| Rate for Payer: Riverside University Health System MISP |
$490.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$736.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$736.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.57
|
| Rate for Payer: United Healthcare All Other HMO |
$448.30
|
| Rate for Payer: United Healthcare HMO Rider |
$438.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,043.12
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$366.30 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Blue Shield of California Commercial |
$326.41
|
| Rate for Payer: Blue Shield of California EPN |
$205.13
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$325.60
|
| Rate for Payer: Cigna of CA HMO |
$284.90
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.75
|
| Rate for Payer: United Healthcare All Other HMO |
$148.68
|
| Rate for Payer: United Healthcare HMO Rider |
$145.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.29
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$366.30 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$326.41
|
| Rate for Payer: Blue Shield of California EPN |
$205.13
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$325.60
|
| Rate for Payer: Cigna of CA HMO |
$284.90
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$284.90
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: Riverside University Health System MISP |
$162.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.75
|
| Rate for Payer: United Healthcare All Other HMO |
$148.68
|
| Rate for Payer: United Healthcare HMO Rider |
$145.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Vantage Medical Group Senior |
$345.95
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Blue Shield of California Commercial |
$441.10
|
| Rate for Payer: Blue Shield of California EPN |
$277.20
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$324.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.41
|
| Rate for Payer: United Healthcare All Other HMO |
$200.91
|
| Rate for Payer: United Healthcare HMO Rider |
$196.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.12
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$302.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$412.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.41
|
| Rate for Payer: Blue Shield of California Commercial |
$348.70
|
| Rate for Payer: Blue Shield of California EPN |
$219.45
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$467.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$467.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$324.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Riverside University Health System MISP |
$220.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.41
|
| Rate for Payer: United Healthcare All Other HMO |
$200.91
|
| Rate for Payer: United Healthcare HMO Rider |
$196.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Vantage Medical Group Senior |
$467.50
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.92
|
| Rate for Payer: Blue Shield of California Commercial |
$729.54
|
| Rate for Payer: Blue Shield of California EPN |
$459.73
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Central Health Plan Commercial |
$926.40
|
| Rate for Payer: Cigna of CA HMO |
$741.12
|
| Rate for Payer: Cigna of CA PPO |
$856.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$810.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$735.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Central Health Plan Commercial |
$926.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$810.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$735.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.60
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
915350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$594.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,087.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$843.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.90
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,232.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,232.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$830.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$920.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$917.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$855.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Riverside University Health System MISP |
$580.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$594.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,087.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$843.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.90
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,232.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,232.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$830.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$920.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$917.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$855.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Riverside University Health System MISP |
$580.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$290.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.90
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$920.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$855.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$942.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
915350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Adventist Health Commercial |
$290.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.90
|
| Rate for Payer: Blue Shield of California EPN |
$730.80
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,305.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$920.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$855.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$1,087.50
|
| Rate for Payer: Networks By Design Commercial |
$942.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
905350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.81 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$341.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.56
|
| Rate for Payer: Blue Shield of California Commercial |
$668.07
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
905350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Blue Shield of California Commercial |
$668.07
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
915350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.81 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$341.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.56
|
| Rate for Payer: Blue Shield of California Commercial |
$668.07
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$416.50
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC TLSO 3 PIECE RIGID SHELL
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT L0492
|
| Hospital Charge Code |
915350492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Blue Shield of California Commercial |
$668.07
|
| Rate for Payer: Blue Shield of California EPN |
$419.83
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$583.10
|
| Rate for Payer: Cigna of CA PPO |
$583.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.62
|
| Rate for Payer: United Healthcare All Other HMO |
$304.29
|
| Rate for Payer: United Healthcare HMO Rider |
$297.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.81
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
915351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.24 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.78
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
915351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.24 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$76.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.78
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC TLSO ABDOMINAL PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1270
|
| Hospital Charge Code |
905351270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Blue Shield of California Commercial |
$149.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.25
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.18
|
| Rate for Payer: United Healthcare All Other HMO |
$68.31
|
| Rate for Payer: United Healthcare HMO Rider |
$66.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
|
