|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.06
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$698.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.06
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
OP
|
$10,402.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,080.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,080.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,841.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,721.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,801.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,680.90
|
| Rate for Payer: Cash Price |
$4,680.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,321.60
|
| Rate for Payer: Cigna of CA HMO |
$6,657.28
|
| Rate for Payer: Cigna of CA PPO |
$7,697.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,841.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,841.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,841.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,160.80
|
| Rate for Payer: Galaxy Health WC |
$8,841.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,361.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,605.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,137.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,080.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,281.40
|
| Rate for Payer: Multiplan Commercial |
$7,801.50
|
| Rate for Payer: Networks By Design Commercial |
$6,761.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,841.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,160.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,201.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,841.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,841.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,841.70
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
IP
|
$10,402.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,080.40 |
| Max. Negotiated Rate |
$9,361.80 |
| Rate for Payer: Adventist Health Commercial |
$2,080.40
|
| Rate for Payer: Cash Price |
$4,680.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,321.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,160.80
|
| Rate for Payer: Galaxy Health WC |
$8,841.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,361.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,605.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,137.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,080.40
|
| Rate for Payer: Multiplan Commercial |
$7,801.50
|
| Rate for Payer: Networks By Design Commercial |
$6,761.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,841.70
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$315.80 |
| Max. Negotiated Rate |
$1,421.10 |
| Rate for Payer: Adventist Health Commercial |
$315.80
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,263.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,105.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.60
|
| Rate for Payer: EPIC Health Plan Senior |
$631.60
|
| Rate for Payer: Galaxy Health WC |
$1,342.15
|
| Rate for Payer: Global Benefits Group Commercial |
$947.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,421.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,002.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$931.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.80
|
| Rate for Payer: Multiplan Commercial |
$1,184.25
|
| Rate for Payer: Networks By Design Commercial |
$1,026.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,342.15
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$315.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,342.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$868.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,263.20
|
| Rate for Payer: Cigna of CA HMO |
$1,026.35
|
| Rate for Payer: Cigna of CA PPO |
$1,168.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,342.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,342.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,342.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,105.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.60
|
| Rate for Payer: EPIC Health Plan Senior |
$631.60
|
| Rate for Payer: Galaxy Health WC |
$1,342.15
|
| Rate for Payer: Global Benefits Group Commercial |
$947.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,421.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,002.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$931.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,105.30
|
| Rate for Payer: Multiplan Commercial |
$1,184.25
|
| Rate for Payer: Networks By Design Commercial |
$1,026.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,342.15
|
| Rate for Payer: Riverside University Health System MISP |
$631.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$947.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$947.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$789.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,342.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,342.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,342.15
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC ANKLE COMPLETE
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Adventist Health Commercial |
$224.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.47
|
| Rate for Payer: Blue Shield of California Commercial |
$707.49
|
| Rate for Payer: Blue Shield of California EPN |
$445.83
|
| Rate for Payer: Cash Price |
$505.35
|
| Rate for Payer: Cash Price |
$505.35
|
| Rate for Payer: Central Health Plan Commercial |
$898.40
|
| Rate for Payer: Cigna of CA HMO |
$718.72
|
| Rate for Payer: Cigna of CA PPO |
$831.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$786.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$954.55
|
| Rate for Payer: Global Benefits Group Commercial |
$673.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$713.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$842.25
|
| Rate for Payer: Networks By Design Commercial |
$729.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$954.55
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC ANKLE COMPLETE
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.60 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Adventist Health Commercial |
$224.60
|
| Rate for Payer: Cash Price |
$505.35
|
| Rate for Payer: Central Health Plan Commercial |
$898.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$786.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.20
|
| Rate for Payer: EPIC Health Plan Senior |
$449.20
|
| Rate for Payer: Galaxy Health WC |
$954.55
|
| Rate for Payer: Global Benefits Group Commercial |
$673.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$713.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$662.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.60
|
| Rate for Payer: Multiplan Commercial |
$842.25
|
| Rate for Payer: Networks By Design Commercial |
$729.95
|
| Rate for Payer: Prime Health Services Commercial |
$954.55
|
|
|
HC ANKLE FOAM STIRRUP ADULT UVRSL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
901698960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$65.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC ANKLE FOAM STIRRUP ADULT UVRSL
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
901698960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Blue Shield of California Commercial |
$65.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
IP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
915355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,722.52 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$9,722.52
|
| Rate for Payer: Blue Shield of California Commercial |
$38,987.29
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,722.52
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$31,598.18
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
OP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
905355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,920.62 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$19,931.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,736.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,459.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,277.94
|
| Rate for Payer: Blue Shield of California Commercial |
$38,987.29
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,320.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,320.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,931.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,028.81
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$24,306.29
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: Riverside University Health System MISP |
$19,445.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,167.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,167.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Senior |
$41,320.69
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
OP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
915355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,920.62 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Dignity Health Medi-Cal |
$41,320.69
|
| Rate for Payer: Adventist Health Commercial |
$19,931.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,736.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,459.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,277.94
|
| Rate for Payer: Blue Shield of California Commercial |
$38,987.29
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,320.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,931.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,028.81
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$24,306.29
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: Riverside University Health System MISP |
$19,445.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,167.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,167.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Senior |
$41,320.69
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
IP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
905355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,722.52 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$9,722.52
|
| Rate for Payer: Blue Shield of California Commercial |
$38,987.29
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,722.52
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$31,598.18
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
|
|
HC ANKLE LIMITED
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC ANKLE LIMITED
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.71 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$604.17
|
| Rate for Payer: Blue Shield of California EPN |
$380.72
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT 91125
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$479.94 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$487.20
|
| Rate for Payer: Adventist Health Commercial |
$601.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,456.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,179.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,417.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,749.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,948.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Cigna of CA HMO |
$1,925.12
|
| Rate for Payer: Cigna of CA HMO |
$1,559.04
|
| Rate for Payer: Cigna of CA PPO |
$1,802.64
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,705.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,105.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$2,070.60
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,910.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,546.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Multiplan Commercial |
$1,827.00
|
| Rate for Payer: Networks By Design Commercial |
$1,583.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,070.60
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,504.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,504.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,504.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,218.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,218.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,504.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 91125
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$601.60 |
| Max. Negotiated Rate |
$2,707.20 |
| Rate for Payer: Adventist Health Commercial |
$601.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,105.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,910.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,774.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC ANOSCOPY AND BIOPSY
|
Facility
|
OP
|
$8,874.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
904000011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$7,986.60 |
| Rate for Payer: Adventist Health Commercial |
$1,774.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$423.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,626.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,540.73
|
| Rate for Payer: Cash Price |
$3,993.30
|
| Rate for Payer: Cash Price |
$3,993.30
|
| Rate for Payer: Cash Price |
$3,993.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,099.20
|
| Rate for Payer: Cigna of CA HMO |
$5,679.36
|
| Rate for Payer: Cigna of CA PPO |
$6,566.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,211.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$7,542.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,324.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,986.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,634.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$6,655.50
|
| Rate for Payer: Networks By Design Commercial |
$5,768.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Prime Health Services Commercial |
$7,542.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,324.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,324.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,437.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,437.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,437.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC ANOSCOPY AND BIOPSY
|
Facility
|
IP
|
$8,874.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
904000011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,774.80 |
| Max. Negotiated Rate |
$7,986.60 |
| Rate for Payer: Adventist Health Commercial |
$1,774.80
|
| Rate for Payer: Cash Price |
$3,993.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,099.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,211.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,549.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,549.60
|
| Rate for Payer: Galaxy Health WC |
$7,542.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,324.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,986.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,634.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,235.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.80
|
| Rate for Payer: Multiplan Commercial |
$6,655.50
|
| Rate for Payer: Networks By Design Commercial |
$5,768.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,542.90
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.20 |
| Max. Negotiated Rate |
$567.90 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.40
|
| Rate for Payer: EPIC Health Plan Senior |
$252.40
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| 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 |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Cigna of CA HMO |
$403.84
|
| Rate for Payer: Cigna of CA PPO |
$466.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$315.50
|
| Rate for Payer: United Healthcare All Other HMO |
$315.50
|
| Rate for Payer: United Healthcare HMO Rider |
$315.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$315.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
