|
HC COMM/WORK REINTEGRATION 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
900417537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.32 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$87.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Senior |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.10
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Riverside University Health System MISP |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC COMPASS IAP KIT
|
Facility
|
OP
|
$453.91
|
|
| Hospital Charge Code |
901698466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$408.52 |
| Rate for Payer: Adventist Health Commercial |
$90.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$275.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$219.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.04
|
| Rate for Payer: Blue Shield of California Commercial |
$287.78
|
| Rate for Payer: Blue Shield of California EPN |
$181.11
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Central Health Plan Commercial |
$363.13
|
| Rate for Payer: Cigna of CA HMO |
$290.50
|
| Rate for Payer: Cigna of CA PPO |
$335.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.56
|
| Rate for Payer: EPIC Health Plan Senior |
$181.56
|
| Rate for Payer: Galaxy Health WC |
$385.82
|
| Rate for Payer: Global Benefits Group Commercial |
$272.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$317.74
|
| Rate for Payer: Multiplan Commercial |
$340.43
|
| Rate for Payer: Networks By Design Commercial |
$295.04
|
| Rate for Payer: Prime Health Services Commercial |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$181.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.96
|
| Rate for Payer: United Healthcare All Other HMO |
$226.96
|
| Rate for Payer: United Healthcare HMO Rider |
$226.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.82
|
| Rate for Payer: Vantage Medical Group Senior |
$385.82
|
|
|
HC COMPASS IAP KIT
|
Facility
|
IP
|
$453.91
|
|
| Hospital Charge Code |
901698466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$408.52 |
| Rate for Payer: Adventist Health Commercial |
$90.78
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Central Health Plan Commercial |
$363.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.56
|
| Rate for Payer: EPIC Health Plan Senior |
$181.56
|
| Rate for Payer: Galaxy Health WC |
$385.82
|
| Rate for Payer: Global Benefits Group Commercial |
$272.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.78
|
| Rate for Payer: Multiplan Commercial |
$340.43
|
| Rate for Payer: Networks By Design Commercial |
$295.04
|
| Rate for Payer: Prime Health Services Commercial |
$385.82
|
|
|
HC COMPASS IAP MINAL PRESSURE KIT
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC COMPASS IAP MINAL PRESSURE KIT
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC COMPLEMENT C-3
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-3
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC COMPLEMENT C-4
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-4
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$205.43 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.43
|
| Rate for Payer: Blue Shield of California Commercial |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$68.67
|
| Rate for Payer: Blue Shield of California EPN |
$31.76
|
| Rate for Payer: Blue Shield of California EPN |
$43.27
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$59.20
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.53
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Medicare |
$21.54
|
| Rate for Payer: Prime Health Services Medicare |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$22.35
|
| Rate for Payer: Riverside University Health System MISP |
$22.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Blue Shield of California Commercial |
$296.74
|
| Rate for Payer: Blue Shield of California EPN |
$186.48
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.86
|
| Rate for Payer: United Healthcare All Other HMO |
$135.16
|
| Rate for Payer: United Healthcare HMO Rider |
$132.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.17
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.91
|
| Rate for Payer: Blue Shield of California Commercial |
$296.74
|
| Rate for Payer: Blue Shield of California EPN |
$186.48
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Riverside University Health System MISP |
$148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.86
|
| Rate for Payer: United Healthcare All Other HMO |
$135.16
|
| Rate for Payer: United Healthcare HMO Rider |
$132.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC COMPOSITE ELASTIC
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
903203946
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Blue Shield of California Commercial |
$140.35
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.68
|
| Rate for Payer: United Healthcare All Other HMO |
$63.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.31
|
|
|
HC COMPOSITE ELASTIC
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
903203946
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$71.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.80
|
| Rate for Payer: Blue Shield of California Commercial |
$140.35
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$87.50
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health System MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.68
|
| Rate for Payer: United Healthcare All Other HMO |
$63.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC COMPREHENSIVE METABOLIC PANEL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
900910423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$107.04 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.04
|
| Rate for Payer: Blue Shield of California Commercial |
$500.85
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California EPN |
$315.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$11.62
|
| Rate for Payer: EPIC Health Plan Senior |
$11.62
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.56
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Medicare |
$11.19
|
| Rate for Payer: Prime Health Services Medicare |
$11.19
|
| Rate for Payer: Riverside University Health System MISP |
$11.62
|
| Rate for Payer: Riverside University Health System MISP |
$11.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.55
|
| Rate for Payer: United Healthcare All Other HMO |
$8.55
|
| Rate for Payer: United Healthcare All Other HMO |
$8.55
|
| Rate for Payer: United Healthcare HMO Rider |
$8.55
|
| Rate for Payer: United Healthcare HMO Rider |
$8.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
HC COMPREHENSIVE METABOLIC PANEL
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
900910423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Senior |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC COMPRESSION BRA
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California Commercial |
$260.65
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
|
|
HC COMPRESSION BRA
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California Commercial |
$260.65
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
|
|
HC COMPRESSION BRA
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.44 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$133.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.05
|
| Rate for Payer: Blue Shield of California Commercial |
$260.65
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Riverside University Health System MISP |
$130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC COMPRESSION BRA
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.44 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$133.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.05
|
| Rate for Payer: Blue Shield of California Commercial |
$260.65
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Riverside University Health System MISP |
$130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC COMPRESSIVE BELT
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC COMPRESSIVE BELT
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC COMPRESSIVE BELT
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC COMPRESSIVE BELT
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$168.42
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
