|
HC WHITE CAP 15MM
|
Facility
|
OP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.25
|
| Rate for Payer: Blue Shield of California Commercial |
$27.31
|
| Rate for Payer: Blue Shield of California EPN |
$17.83
|
| Rate for Payer: Cash Price |
$24.58
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: InnovAge PACE Commercial |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Riverside University Health System MISP |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC WHITE CAP 15MM
|
Facility
|
IP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$24.58
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC WHO ADD TO OPPONENS ACTN W/FLX
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
903203850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$100.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.89
|
| Rate for Payer: Blue Shield of California Commercial |
$189.38
|
| Rate for Payer: Blue Shield of California EPN |
$123.48
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$171.50
|
| Rate for Payer: Cigna of CA PPO |
$171.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: InnovAge PACE Commercial |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$171.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$122.50
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health System MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.95
|
| Rate for Payer: United Healthcare All Other HMO |
$89.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC WHO ADD TO OPPONENS ACTN W/FLX
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
903203850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Blue Shield of California Commercial |
$189.38
|
| Rate for Payer: Blue Shield of California EPN |
$123.48
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$171.50
|
| Rate for Payer: Cigna of CA PPO |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.95
|
| Rate for Payer: United Healthcare All Other HMO |
$89.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.24
|
|
|
HC WHO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
905353909
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC WHO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
905353909
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$15.28
|
| Rate for Payer: Blue Shield of California EPN |
$9.97
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC WHO W/JOINT(S) CF
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
903203915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.20 |
| Max. Negotiated Rate |
$891.90 |
| Rate for Payer: Adventist Health Commercial |
$198.20
|
| Rate for Payer: Blue Shield of California Commercial |
$766.04
|
| Rate for Payer: Blue Shield of California EPN |
$499.46
|
| Rate for Payer: Cash Price |
$545.05
|
| Rate for Payer: Central Health Plan Commercial |
$792.80
|
| Rate for Payer: Cigna of CA HMO |
$693.70
|
| Rate for Payer: Cigna of CA PPO |
$693.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.40
|
| Rate for Payer: EPIC Health Plan Senior |
$396.40
|
| Rate for Payer: Galaxy Health WC |
$842.35
|
| Rate for Payer: Global Benefits Group Commercial |
$594.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$613.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.20
|
| Rate for Payer: Multiplan Commercial |
$743.25
|
| Rate for Payer: Networks By Design Commercial |
$644.15
|
| Rate for Payer: Prime Health Services Commercial |
$842.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$371.92
|
| Rate for Payer: United Healthcare All Other HMO |
$362.01
|
| Rate for Payer: United Healthcare HMO Rider |
$354.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.55
|
|
|
HC WHO W/JOINT(S) CF
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
903203915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.55 |
| Max. Negotiated Rate |
$891.90 |
| Rate for Payer: Adventist Health Commercial |
$406.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$842.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$545.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$743.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$582.01
|
| Rate for Payer: Blue Shield of California Commercial |
$766.04
|
| Rate for Payer: Blue Shield of California EPN |
$499.46
|
| Rate for Payer: Cash Price |
$545.05
|
| Rate for Payer: Cash Price |
$545.05
|
| Rate for Payer: Central Health Plan Commercial |
$792.80
|
| Rate for Payer: Cigna of CA HMO |
$693.70
|
| Rate for Payer: Cigna of CA PPO |
$693.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$842.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$842.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.40
|
| Rate for Payer: EPIC Health Plan Senior |
$396.40
|
| Rate for Payer: Galaxy Health WC |
$842.35
|
| Rate for Payer: Global Benefits Group Commercial |
$594.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$545.55
|
| Rate for Payer: InnovAge PACE Commercial |
$495.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$613.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$693.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$693.70
|
| Rate for Payer: Multiplan Commercial |
$743.25
|
| Rate for Payer: Networks By Design Commercial |
$495.50
|
| Rate for Payer: Prime Health Services Commercial |
$842.35
|
| Rate for Payer: Riverside University Health System MISP |
$396.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$594.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$594.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$371.92
|
| Rate for Payer: United Healthcare All Other HMO |
$362.01
|
| Rate for Payer: United Healthcare HMO Rider |
$354.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$842.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.35
|
| Rate for Payer: Vantage Medical Group Senior |
$842.35
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
915353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$296.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.04
|
| Rate for Payer: Blue Shield of California EPN |
$745.92
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$962.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$296.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.04
|
| Rate for Payer: Blue Shield of California EPN |
$745.92
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$962.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$484.70 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$606.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,110.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.04
|
| Rate for Payer: Blue Shield of California EPN |
$745.92
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,258.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,258.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$975.84
|
| Rate for Payer: InnovAge PACE Commercial |
$740.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,036.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,036.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Riverside University Health System MISP |
$592.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
915353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$484.70 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$606.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,110.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.04
|
| Rate for Payer: Blue Shield of California EPN |
$745.92
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Cash Price |
$814.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,258.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,258.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$975.84
|
| Rate for Payer: InnovAge PACE Commercial |
$740.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$916.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,036.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,036.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Riverside University Health System MISP |
$592.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
OP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
905353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.50 |
| Max. Negotiated Rate |
$1,210.53 |
| Rate for Payer: Adventist Health Commercial |
$551.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$739.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.71
|
| Rate for Payer: Blue Shield of California EPN |
$677.90
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.02
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,143.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,143.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$545.55
|
| Rate for Payer: InnovAge PACE Commercial |
$672.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$941.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.52
|
| Rate for Payer: Multiplan Commercial |
$1,008.77
|
| Rate for Payer: Networks By Design Commercial |
$672.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: Riverside University Health System MISP |
$538.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.28
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
IP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
905353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$1,210.53 |
| Rate for Payer: Adventist Health Commercial |
$269.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.71
|
| Rate for Payer: Blue Shield of California EPN |
$677.90
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.02
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.01
|
| Rate for Payer: Multiplan Commercial |
$1,008.77
|
| Rate for Payer: Networks By Design Commercial |
$874.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
OP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
915353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.50 |
| Max. Negotiated Rate |
$1,210.53 |
| Rate for Payer: Adventist Health Commercial |
$551.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$739.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.71
|
| Rate for Payer: Blue Shield of California EPN |
$677.90
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.02
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,143.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,143.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$545.55
|
| Rate for Payer: InnovAge PACE Commercial |
$672.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$941.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.52
|
| Rate for Payer: Multiplan Commercial |
$1,008.77
|
| Rate for Payer: Networks By Design Commercial |
$672.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: Riverside University Health System MISP |
$538.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.28
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
IP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
915353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$1,210.53 |
| Rate for Payer: Adventist Health Commercial |
$269.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.71
|
| Rate for Payer: Blue Shield of California EPN |
$677.90
|
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.02
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.01
|
| Rate for Payer: Multiplan Commercial |
$1,008.77
|
| Rate for Payer: Networks By Design Commercial |
$874.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
|
|
HC WINDOWING OF CAST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC WINDOWING OF CAST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$505.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$748.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.14
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC WINDOWING OF CAST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| 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 |
$319.45
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.50
|
| Rate for Payer: United Healthcare All Other HMO |
$616.50
|
| Rate for Payer: United Healthcare HMO Rider |
$616.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC WINDOWING OF CAST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: InnovAge PACE Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC WIPE ADHESIVE REMOVER BRAVA
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
CPT A4456
|
| Hospital Charge Code |
901606877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
|
IP
|
$3.44
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
HC WIPE CAVILON BARRIER FILM
|
Facility
|
OP
|
$3.44
|
|
| Hospital Charge Code |
901606220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
HC WIPE SUREPREP BARRIER FILM
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: InnovAge PACE Commercial |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
