|
HC WOUND MATRIX NEOX FLO 25MG PARTICULATE
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.05
|
| Rate for Payer: Blue Shield of California Commercial |
$46.92
|
| Rate for Payer: Blue Shield of California EPN |
$29.53
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: Cigna of CA HMO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$37.00
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Riverside University Health System MISP |
$29.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.77
|
| Rate for Payer: United Healthcare All Other HMO |
$27.03
|
| Rate for Payer: United Healthcare HMO Rider |
$26.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.90
|
| Rate for Payer: Vantage Medical Group Senior |
$62.90
|
|
|
HC WOUND MATRIX NEOX FLO 50MG PARTICULATE
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California Commercial |
$37.69
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
|
HC WOUND MATRIX NEOX FLO 50MG PARTICULATE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.34
|
| Rate for Payer: Blue Shield of California Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California EPN |
$18.75
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$207.60
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$285.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$389.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$441.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$441.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$207.60
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$313.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$363.30
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Riverside University Health System MISP |
$207.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$441.15
|
| Rate for Payer: Vantage Medical Group Senior |
$441.15
|
|
|
HC WRIST COCK-UP-DORSAL SPLINT
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Blue Shield of California Commercial |
$231.78
|
| Rate for Payer: Blue Shield of California EPN |
$145.66
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$202.30
|
| Rate for Payer: Cigna of CA PPO |
$202.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$202.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Senior |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$183.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$170.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.46
|
| Rate for Payer: United Healthcare All Other HMO |
$105.57
|
| Rate for Payer: United Healthcare HMO Rider |
$103.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.65
|
|
|
HC WRIST COCK-UP-DORSAL SPLINT
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.65 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$118.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.11
|
| Rate for Payer: Blue Shield of California Commercial |
$231.78
|
| Rate for Payer: Blue Shield of California EPN |
$145.66
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$202.30
|
| Rate for Payer: Cigna of CA PPO |
$202.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$245.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$202.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Senior |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$183.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$170.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$202.30
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Riverside University Health System MISP |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.46
|
| Rate for Payer: United Healthcare All Other HMO |
$105.57
|
| Rate for Payer: United Healthcare HMO Rider |
$103.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$995.40 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.40
|
| 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 |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.47
|
| Rate for Payer: Blue Shield of California Commercial |
$696.78
|
| Rate for Payer: Blue Shield of California EPN |
$439.08
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| Rate for Payer: Cigna of CA HMO |
$707.84
|
| Rate for Payer: Cigna of CA PPO |
$818.44
|
| 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 |
$774.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$995.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
| 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 |
$663.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$663.60
|
| 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 WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$995.40 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.40
|
| Rate for Payer: EPIC Health Plan Senior |
$442.40
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$995.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
|
|
HC WRIST EXT,COCK-UP W/OUTRIGGER
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203916
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.01
|
| Rate for Payer: Blue Shield of California Commercial |
$157.19
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC WRIST EXT,COCK-UP W/OUTRIGGER
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203916
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Blue Shield of California Commercial |
$157.19
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC WRIST LIMITED
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.65
|
| 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 |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$578.97
|
| Rate for Payer: Blue Shield of California EPN |
$364.84
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: Cigna of CA HMO |
$588.16
|
| Rate for Payer: Cigna of CA PPO |
$680.06
|
| 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 |
$643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$583.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
| 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 |
$551.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$551.40
|
| 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 WRIST LIMITED
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$583.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$542.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
|
|
HC WRIST WRAP (L/U)
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901603171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC WRIST WRAP (L/U)
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901603171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC WRIST WRAP (R/U)
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901603170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC WRIST WRAP (R/U)
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901603170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$112.48 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.48
|
| Rate for Payer: Blue Shield of California Commercial |
$77.49
|
| Rate for Payer: Blue Shield of California Commercial |
$74.97
|
| Rate for Payer: Blue Shield of California EPN |
$48.83
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$447.66 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.36
|
| Rate for Payer: Blue Shield of California Commercial |
$121.73
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Riverside University Health System MISP |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$153.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$271.62 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$909.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$911.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,266.61
|
| Rate for Payer: Blue Shield of California Commercial |
$921.06
|
| Rate for Payer: Blue Shield of California EPN |
$580.41
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$271.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.19
|
| Rate for Payer: United Healthcare All Other HMO |
$518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$518.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,300.40 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,049.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,288.22
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,044.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.20
|
| Rate for Payer: Cigna of CA PPO |
$1,789.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,300.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,623.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,508.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: Networks By Design Commercial |
$1,278.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$959.27
|
| Rate for Payer: United Healthcare All Other HMO |
$933.71
|
| Rate for Payer: United Healthcare HMO Rider |
$913.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.09
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,300.40 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,405.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,167.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,401.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,049.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,288.22
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,044.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.20
|
| Rate for Payer: Cigna of CA PPO |
$1,789.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,172.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,172.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,300.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,623.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$927.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,508.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,789.20
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: Networks By Design Commercial |
$1,278.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,022.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,533.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$959.27
|
| Rate for Payer: United Healthcare All Other HMO |
$933.71
|
| Rate for Payer: United Healthcare HMO Rider |
$913.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,172.60
|
|
