|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
|
OP
|
$4,019.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.58 |
| Max. Negotiated Rate |
$3,617.10 |
| Rate for Payer: Adventist Health Commercial |
$803.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,210.45
|
| Rate for Payer: Cash Price |
$2,210.45
|
| Rate for Payer: Cash Price |
$2,210.45
|
| Rate for Payer: Cash Price |
$2,210.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,215.20
|
| Rate for Payer: Cigna of CA HMO |
$2,572.16
|
| Rate for Payer: Cigna of CA PPO |
$2,974.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$3,416.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,411.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,617.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,680.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$803.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$3,014.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,612.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$3,416.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,411.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,009.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,009.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,009.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,009.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.40
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California EPN |
$31.52
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: InnovAge PACE Commercial |
$39.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Riverside University Health System MISP |
$31.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TRUFILL N-BCA
|
Facility
|
OP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$5,611.50 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,786.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,429.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,676.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,018.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,661.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3,809.59
|
| Rate for Payer: Blue Shield of California EPN |
$2,487.76
|
| Rate for Payer: Cash Price |
$3,429.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,988.00
|
| Rate for Payer: Cigna of CA HMO |
$3,990.40
|
| Rate for Payer: Cigna of CA PPO |
$4,613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,299.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,299.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,494.00
|
| Rate for Payer: Galaxy Health WC |
$5,299.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,741.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,611.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,117.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,158.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,859.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,247.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,364.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,364.50
|
| Rate for Payer: Multiplan Commercial |
$4,676.25
|
| Rate for Payer: Networks By Design Commercial |
$4,052.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,299.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,494.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,741.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,741.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,117.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,117.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,117.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,117.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,299.75
|
|
|
HC TRUFILL N-BCA
|
Facility
|
IP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$5,611.50 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Cash Price |
$3,429.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,494.00
|
| Rate for Payer: Galaxy Health WC |
$5,299.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,741.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,611.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,158.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,859.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,247.00
|
| Rate for Payer: Multiplan Commercial |
$4,676.25
|
| Rate for Payer: Networks By Design Commercial |
$4,052.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,299.75
|
|
|
HC TRUSS ADDITION SCROTAL PAD
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT L8330
|
| Hospital Charge Code |
905358330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Adventist Health Commercial |
$58.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.98
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$72.07
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$100.10
|
| Rate for Payer: Cigna of CA PPO |
$100.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.84
|
| Rate for Payer: InnovAge PACE Commercial |
$71.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Riverside University Health System MISP |
$57.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.67
|
| Rate for Payer: United Healthcare All Other HMO |
$52.24
|
| Rate for Payer: United Healthcare HMO Rider |
$51.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Vantage Medical Group Senior |
$121.55
|
|
|
HC TRUSS ADDITION SCROTAL PAD
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT L8330
|
| Hospital Charge Code |
905358330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$72.07
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$100.10
|
| Rate for Payer: Cigna of CA PPO |
$100.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.67
|
| Rate for Payer: United Healthcare All Other HMO |
$52.24
|
| Rate for Payer: United Healthcare HMO Rider |
$51.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.83
|
|
|
HC TRUSS ADDITION WATER PAD
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L8320
|
| Hospital Charge Code |
905358320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$125.23
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC TRUSS ADDITION WATER PAD
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L8320
|
| Hospital Charge Code |
905358320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.37 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.14
|
| Rate for Payer: Blue Shield of California Commercial |
$125.23
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.37
|
| Rate for Payer: InnovAge PACE Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health System MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC TRUSS DOUBLE W/STANDARD PADS
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT L8310
|
| Hospital Charge Code |
905358310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Adventist Health Commercial |
$159.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.46
|
| Rate for Payer: Blue Shield of California Commercial |
$300.70
|
| Rate for Payer: Blue Shield of California EPN |
$196.06
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: Cigna of CA HMO |
$272.30
|
| Rate for Payer: Cigna of CA PPO |
$272.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$330.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.96
|
| Rate for Payer: InnovAge PACE Commercial |
$194.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$272.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$272.30
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$194.50
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
| Rate for Payer: Riverside University Health System MISP |
$155.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$233.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$233.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.99
|
| Rate for Payer: United Healthcare All Other HMO |
$142.10
|
| Rate for Payer: United Healthcare HMO Rider |
$139.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.65
|
| Rate for Payer: Vantage Medical Group Senior |
$330.65
|
|
|
HC TRUSS DOUBLE W/STANDARD PADS
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT L8310
|
| Hospital Charge Code |
905358310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Blue Shield of California Commercial |
$300.70
|
| Rate for Payer: Blue Shield of California EPN |
$196.06
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: Cigna of CA HMO |
$272.30
|
| Rate for Payer: Cigna of CA PPO |
$272.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.99
|
| Rate for Payer: United Healthcare All Other HMO |
$142.10
|
| Rate for Payer: United Healthcare HMO Rider |
$139.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.40
|
|
|
HC TRUSS SINGLE W/STANDARD PAD
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L8300
|
| Hospital Charge Code |
905358300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.30
|
| Rate for Payer: Blue Shield of California Commercial |
$139.91
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.12
|
| Rate for Payer: InnovAge PACE Commercial |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Riverside University Health System MISP |
$72.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC TRUSS SINGLE W/STANDARD PAD
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L8300
|
| Hospital Charge Code |
905358300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Blue Shield of California Commercial |
$139.91
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC TRUWAVE DBL A-LINE CVP
|
Facility
|
OP
|
$268.66
|
|
| Hospital Charge Code |
901698617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$241.79 |
| Rate for Payer: Adventist Health Commercial |
$53.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.78
|
| Rate for Payer: Blue Shield of California Commercial |
$164.15
|
| Rate for Payer: Blue Shield of California EPN |
$107.20
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Central Health Plan Commercial |
$214.93
|
| Rate for Payer: Cigna of CA HMO |
$171.94
|
| Rate for Payer: Cigna of CA PPO |
$198.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.46
|
| Rate for Payer: EPIC Health Plan Senior |
$107.46
|
| Rate for Payer: Galaxy Health WC |
$228.36
|
| Rate for Payer: Global Benefits Group Commercial |
$161.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.79
|
| Rate for Payer: InnovAge PACE Commercial |
$134.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.06
|
| Rate for Payer: Multiplan Commercial |
$201.50
|
| Rate for Payer: Networks By Design Commercial |
$174.63
|
| Rate for Payer: Prime Health Services Commercial |
$228.36
|
| Rate for Payer: Riverside University Health System MISP |
$107.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.33
|
| Rate for Payer: United Healthcare All Other HMO |
$134.33
|
| Rate for Payer: United Healthcare HMO Rider |
$134.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.36
|
| Rate for Payer: Vantage Medical Group Senior |
$228.36
|
|
|
HC TRUWAVE DBL A-LINE CVP
|
Facility
|
IP
|
$268.66
|
|
| Hospital Charge Code |
901698617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$241.79 |
| Rate for Payer: Adventist Health Commercial |
$53.73
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Central Health Plan Commercial |
$214.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.46
|
| Rate for Payer: EPIC Health Plan Senior |
$107.46
|
| Rate for Payer: Galaxy Health WC |
$228.36
|
| Rate for Payer: Global Benefits Group Commercial |
$161.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.73
|
| Rate for Payer: Multiplan Commercial |
$201.50
|
| Rate for Payer: Networks By Design Commercial |
$174.63
|
| Rate for Payer: Prime Health Services Commercial |
$228.36
|
|
|
HC TRYPSIN STOOL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC TRYPSIN STOOL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$53.09 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.77
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.86
|
| Rate for Payer: EPIC Health Plan Senior |
$7.30
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.30
|
| Rate for Payer: InnovAge PACE Commercial |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$7.74
|
| Rate for Payer: Riverside University Health System MISP |
$8.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Vantage Medical Group Senior |
$7.30
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
IP
|
$142.63
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$128.37 |
| Rate for Payer: Adventist Health Commercial |
$28.53
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: Central Health Plan Commercial |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.05
|
| Rate for Payer: EPIC Health Plan Senior |
$57.05
|
| Rate for Payer: Galaxy Health WC |
$121.24
|
| Rate for Payer: Global Benefits Group Commercial |
$85.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.53
|
| Rate for Payer: Multiplan Commercial |
$106.97
|
| Rate for Payer: Networks By Design Commercial |
$92.71
|
| Rate for Payer: Prime Health Services Commercial |
$121.24
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
OP
|
$142.63
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$128.37 |
| Rate for Payer: Adventist Health Commercial |
$28.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.81
|
| Rate for Payer: Blue Shield of California Commercial |
$86.58
|
| Rate for Payer: Blue Shield of California EPN |
$56.62
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: Central Health Plan Commercial |
$114.10
|
| Rate for Payer: Cigna of CA HMO |
$91.28
|
| Rate for Payer: Cigna of CA PPO |
$105.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$121.24
|
| Rate for Payer: Global Benefits Group Commercial |
$85.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: InnovAge PACE Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$106.97
|
| Rate for Payer: Networks By Design Commercial |
$92.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Medicare |
$17.81
|
| Rate for Payer: Riverside University Health System MISP |
$18.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
905352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Blue Shield of California Commercial |
$131.41
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
905352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$131.41
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.17
|
| Rate for Payer: InnovAge PACE Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
915352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$131.41
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.17
|
| Rate for Payer: InnovAge PACE Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
915352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Blue Shield of California Commercial |
$131.41
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC TTE W OR W/O FOL W/CON,DOPPLER
|
Facility
|
OP
|
$1,703.00
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
900200256
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$340.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,034.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,033.72
|
| Rate for Payer: Blue Shield of California EPN |
$676.09
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: Cigna of CA HMO |
$1,089.92
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC TTE W OR W/O FOL W/CON,DOPPLER
|
Facility
|
IP
|
$1,703.00
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
900200256
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,532.70 |
| Rate for Payer: Adventist Health Commercial |
$340.60
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: EPIC Health Plan Senior |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,054.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
