|
HC TLSO TRIPLANAR CNTRL SEG 3 SHE
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT L0462
|
| Hospital Charge Code |
915350462
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Adventist Health Commercial |
$480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,855.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,920.00
|
| Rate for Payer: Cigna of CA HMO |
$1,680.00
|
| Rate for Payer: Cigna of CA PPO |
$1,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$960.00
|
| Rate for Payer: Galaxy Health WC |
$2,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,440.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,600.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,485.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.72
|
| Rate for Payer: United Healthcare All Other HMO |
$876.72
|
| Rate for Payer: United Healthcare HMO Rider |
$857.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
915350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,934.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,261.01
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
915350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$819.40 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Adventist Health Commercial |
$1,025.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,376.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,876.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,469.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,934.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,261.01
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,126.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,607.13
|
| Rate for Payer: InnovAge PACE Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,751.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,000.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,934.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,261.01
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$819.40 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Adventist Health Commercial |
$1,025.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,376.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,876.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,469.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,934.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,261.01
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,751.40
|
| Rate for Payer: Cigna of CA PPO |
$1,751.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,126.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,607.13
|
| Rate for Payer: InnovAge PACE Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,751.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,000.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$913.98
|
| Rate for Payer: United Healthcare HMO Rider |
$894.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$553.48 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Adventist Health Commercial |
$692.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$992.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.37
|
| Rate for Payer: Blue Shield of California EPN |
$851.76
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,085.32
|
| Rate for Payer: InnovAge PACE Commercial |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$692.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Riverside University Health System MISP |
$676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
915350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$553.48 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Adventist Health Commercial |
$692.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$992.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.37
|
| Rate for Payer: Blue Shield of California EPN |
$851.76
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,085.32
|
| Rate for Payer: InnovAge PACE Commercial |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$692.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$845.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Riverside University Health System MISP |
$676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.37
|
| Rate for Payer: Blue Shield of California EPN |
$851.76
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
915350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.37
|
| Rate for Payer: Blue Shield of California EPN |
$851.76
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.26
|
| Rate for Payer: United Healthcare All Other HMO |
$617.36
|
| Rate for Payer: United Healthcare HMO Rider |
$604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$553.48
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$358.29 |
| Max. Negotiated Rate |
$1,065.18 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$642.51
|
| Rate for Payer: Blue Shield of California Commercial |
$845.66
|
| Rate for Payer: Blue Shield of California EPN |
$551.38
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$964.27
|
| Rate for Payer: InnovAge PACE Commercial |
$547.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Riverside University Health System MISP |
$437.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
905350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Blue Shield of California Commercial |
$845.66
|
| Rate for Payer: Blue Shield of California EPN |
$551.38
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
915350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Blue Shield of California Commercial |
$845.66
|
| Rate for Payer: Blue Shield of California EPN |
$551.38
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
|
|
HC TLSO TRIPLANAR CNTRL SEG XYPHO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT L0458
|
| Hospital Charge Code |
915350458
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$358.29 |
| Max. Negotiated Rate |
$1,065.18 |
| Rate for Payer: Adventist Health Commercial |
$448.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$642.51
|
| Rate for Payer: Blue Shield of California Commercial |
$845.66
|
| Rate for Payer: Blue Shield of California EPN |
$551.38
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$765.80
|
| Rate for Payer: Cigna of CA PPO |
$765.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$964.27
|
| Rate for Payer: InnovAge PACE Commercial |
$547.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$547.00
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Riverside University Health System MISP |
$437.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.58
|
| Rate for Payer: United Healthcare All Other HMO |
$399.64
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
905350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$794.19 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$994.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,424.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,874.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,061.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,061.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,085.32
|
| Rate for Payer: InnovAge PACE Commercial |
$1,212.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,697.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,697.50
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Riverside University Health System MISP |
$970.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,061.25
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
915350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$794.19 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$994.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,424.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,874.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,061.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,061.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,085.32
|
| Rate for Payer: InnovAge PACE Commercial |
$1,212.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,697.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,697.50
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Riverside University Health System MISP |
$970.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,061.25
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
915350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,874.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,576.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
|
|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
905350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,874.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,576.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.66
|
| Rate for Payer: InnovAge PACE Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Riverside University Health System MISP |
$146.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.10
|
| Rate for Payer: Vantage Medical Group Senior |
$311.10
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$582.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$582.11
|
| Rate for Payer: Blue Shield of California EPN |
$380.72
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Adventist Health Commercial |
$371.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,127.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$437.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,126.59
|
| Rate for Payer: Blue Shield of California EPN |
$736.83
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,484.80
|
| Rate for Payer: Cigna of CA HMO |
$1,187.84
|
| Rate for Payer: Cigna of CA PPO |
$1,373.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,577.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,113.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,670.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,237.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,206.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,577.60
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,113.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Adventist Health Commercial |
$371.20
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.40
|
| Rate for Payer: EPIC Health Plan Senior |
$742.40
|
| Rate for Payer: Galaxy Health WC |
$1,577.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,113.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,670.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,237.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,148.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.20
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,206.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,577.60
|
|
|
HC TOBRAMYCIN
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC TOBRAMYCIN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$117.25 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.78
|
| Rate for Payer: EPIC Health Plan Senior |
$16.13
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: InnovAge PACE Commercial |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.61
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.13
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$17.10
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO |
$13.07
|
| Rate for Payer: United Healthcare HMO Rider |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
|
