|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
IP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$135.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$127.36
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
OP
|
$136.72
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$123.05 |
| Rate for Payer: Adventist Health Commercial |
$27.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.30
|
| Rate for Payer: Blue Shield of California Commercial |
$83.54
|
| Rate for Payer: Blue Shield of California EPN |
$54.55
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Central Health Plan Commercial |
$109.38
|
| Rate for Payer: Cigna of CA HMO |
$87.50
|
| Rate for Payer: Cigna of CA PPO |
$101.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.69
|
| Rate for Payer: EPIC Health Plan Senior |
$54.69
|
| Rate for Payer: Galaxy Health WC |
$116.21
|
| Rate for Payer: Global Benefits Group Commercial |
$82.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.05
|
| Rate for Payer: InnovAge PACE Commercial |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$102.54
|
| Rate for Payer: Networks By Design Commercial |
$88.87
|
| Rate for Payer: Prime Health Services Commercial |
$116.21
|
| Rate for Payer: Riverside University Health System MISP |
$54.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.36
|
| Rate for Payer: United Healthcare All Other HMO |
$68.36
|
| Rate for Payer: United Healthcare HMO Rider |
$68.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.21
|
| Rate for Payer: Vantage Medical Group Senior |
$116.21
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
IP
|
$136.72
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$123.05 |
| Rate for Payer: Adventist Health Commercial |
$27.34
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Central Health Plan Commercial |
$109.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.69
|
| Rate for Payer: EPIC Health Plan Senior |
$54.69
|
| Rate for Payer: Galaxy Health WC |
$116.21
|
| Rate for Payer: Global Benefits Group Commercial |
$82.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.34
|
| Rate for Payer: Multiplan Commercial |
$102.54
|
| Rate for Payer: Networks By Design Commercial |
$88.87
|
| Rate for Payer: Prime Health Services Commercial |
$116.21
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
OP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.38
|
| Rate for Payer: Blue Shield of California Commercial |
$39.93
|
| Rate for Payer: Blue Shield of California EPN |
$26.07
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: Cigna of CA HMO |
$41.82
|
| Rate for Payer: Cigna of CA PPO |
$48.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.81
|
| Rate for Payer: InnovAge PACE Commercial |
$32.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.74
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
| Rate for Payer: Riverside University Health System MISP |
$26.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.67
|
| Rate for Payer: United Healthcare All Other HMO |
$32.67
|
| Rate for Payer: United Healthcare HMO Rider |
$32.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Vantage Medical Group Senior |
$55.55
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
IP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
OP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.07
|
| Rate for Payer: Blue Shield of California Commercial |
$70.81
|
| Rate for Payer: Blue Shield of California EPN |
$46.24
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.72
|
| Rate for Payer: Cigna of CA HMO |
$74.18
|
| Rate for Payer: Cigna of CA PPO |
$85.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.31
|
| Rate for Payer: InnovAge PACE Commercial |
$57.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.13
|
| Rate for Payer: Multiplan Commercial |
$86.92
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
| Rate for Payer: Riverside University Health System MISP |
$46.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Other HMO |
$57.95
|
| Rate for Payer: United Healthcare HMO Rider |
$57.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Vantage Medical Group Senior |
$98.52
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
IP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$63.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$86.92
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
IP
|
$15,482.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,096.40 |
| Max. Negotiated Rate |
$13,933.80 |
| Rate for Payer: Adventist Health Commercial |
$3,096.40
|
| Rate for Payer: Cash Price |
$8,515.10
|
| Rate for Payer: Central Health Plan Commercial |
$12,385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,192.80
|
| Rate for Payer: Galaxy Health WC |
$13,159.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,933.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,326.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,898.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,583.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,096.40
|
| Rate for Payer: Multiplan Commercial |
$11,611.50
|
| Rate for Payer: Networks By Design Commercial |
$10,063.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,159.70
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$15,482.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$13,933.80 |
| Rate for Payer: Adventist Health Commercial |
$3,096.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$8,515.10
|
| Rate for Payer: Cash Price |
$8,515.10
|
| Rate for Payer: Cash Price |
$8,515.10
|
| Rate for Payer: Cash Price |
$8,515.10
|
| Rate for Payer: Central Health Plan Commercial |
$12,385.60
|
| Rate for Payer: Cigna of CA HMO |
$9,908.48
|
| Rate for Payer: Cigna of CA PPO |
$11,456.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$13,159.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,933.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,326.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,096.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$11,611.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$10,063.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$13,159.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,741.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,741.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,741.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,741.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,772.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$554.40 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.60
|
| Rate for Payer: Cigna of CA HMO |
$1,774.08
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,494.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,079.00
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,772.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| 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 |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.60
|
| Rate for Payer: Cigna of CA HMO |
$1,774.08
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,494.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,079.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,386.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,386.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Cash Price |
$906.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Senior |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,484.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,020.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$906.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,236.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$798.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$968.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$906.95
|
| Rate for Payer: Cash Price |
$906.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,319.20
|
| Rate for Payer: Cigna of CA HMO |
$1,055.36
|
| Rate for Payer: Cigna of CA PPO |
$1,220.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,401.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,401.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Senior |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,484.10
|
| Rate for Payer: InnovAge PACE Commercial |
$824.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,020.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,154.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,154.30
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
| Rate for Payer: Riverside University Health System MISP |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$989.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$2,772.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$554.40 |
| Max. Negotiated Rate |
$2,494.80 |
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.80
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,494.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,056.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,715.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$2,079.00
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$2,772.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$554.40 |
| Max. Negotiated Rate |
$2,494.80 |
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.80
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,494.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,056.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,715.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$2,079.00
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
OP
|
$11,429.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$10,286.10 |
| Rate for Payer: Adventist Health Commercial |
$2,285.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$6,285.95
|
| Rate for Payer: Cash Price |
$6,285.95
|
| Rate for Payer: Cash Price |
$6,285.95
|
| Rate for Payer: Cash Price |
$6,285.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,143.20
|
| Rate for Payer: Cigna of CA HMO |
$7,314.56
|
| Rate for Payer: Cigna of CA PPO |
$8,457.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$9,714.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,857.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,286.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,623.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,285.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$8,571.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$7,428.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$9,714.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,857.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,714.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,714.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,714.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,714.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
IP
|
$11,429.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,285.80 |
| Max. Negotiated Rate |
$10,286.10 |
| Rate for Payer: Adventist Health Commercial |
$2,285.80
|
| Rate for Payer: Cash Price |
$6,285.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,143.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,571.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,571.60
|
| Rate for Payer: Galaxy Health WC |
$9,714.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,857.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,286.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,623.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,354.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,074.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,285.80
|
| Rate for Payer: Multiplan Commercial |
$8,571.75
|
| Rate for Payer: Networks By Design Commercial |
$7,428.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,714.65
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.58 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.62
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: InnovAge PACE Commercial |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Riverside University Health System MISP |
$440.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$715.65
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$715.65
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.58 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.62
|
| Rate for Payer: Blue Shield of California Commercial |
$851.07
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Cash Price |
$605.55
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: InnovAge PACE Commercial |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Riverside University Health System MISP |
$440.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC ADJUSTABLE MOBILE ARM SUPPORT
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT L3964
|
| Hospital Charge Code |
903203964
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$995.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,394.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$794.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$963.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,002.04
|
| Rate for Payer: Blue Shield of California EPN |
$654.36
|
| Rate for Payer: Cash Price |
$902.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,312.00
|
| Rate for Payer: Cigna of CA HMO |
$1,049.60
|
| Rate for Payer: Cigna of CA PPO |
$1,213.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,394.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,394.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,394.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$656.00
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,476.00
|
| Rate for Payer: InnovAge PACE Commercial |
$820.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,093.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,015.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,148.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,148.00
|
| Rate for Payer: Multiplan Commercial |
$1,230.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
| Rate for Payer: Riverside University Health System MISP |
$656.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$984.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$984.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$820.00
|
| Rate for Payer: United Healthcare All Other HMO |
$820.00
|
| Rate for Payer: United Healthcare HMO Rider |
$820.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$820.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,394.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,394.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,394.00
|
|
|
HC ADJUSTABLE MOBILE ARM SUPPORT
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT L3964
|
| Hospital Charge Code |
903203964
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Cash Price |
$902.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,312.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$656.00
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,476.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,093.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,015.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.00
|
| Rate for Payer: Multiplan Commercial |
$1,230.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| 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
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| 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 Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$149.69
|
| Rate for Payer: Blue Shield of California EPN |
$97.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.48
|
| 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 |
$141.93
|
| 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: 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 |
$159.25
|
| 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: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| 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
|
|
