|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.03 |
| Max. Negotiated Rate |
$3,164.63 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,756.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.63
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,109.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,917.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,164.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2,109.76
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,145.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,759.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,685.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,570.07
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,917.96
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,033.04
|
| Rate for Payer: Riverside University Health System MISP |
$2,109.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,917.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,109.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.96
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,764.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,430.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.50 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,279.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,764.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Riverside University Health System MISP |
$880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.50 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,279.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,764.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Riverside University Health System MISP |
$880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,764.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,108.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,430.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Blue Shield of California Commercial |
$637.37
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.95
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$516.57
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Blue Shield of California Commercial |
$637.37
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.95
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$516.57
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.27 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.29
|
| Rate for Payer: Blue Shield of California Commercial |
$637.37
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Riverside University Health System MISP |
$317.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.27 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.29
|
| Rate for Payer: Blue Shield of California Commercial |
$637.37
|
| Rate for Payer: Blue Shield of California EPN |
$400.54
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Riverside University Health System MISP |
$317.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$3,369.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$3,369.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,697.76 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,015.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,073.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,697.76 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,015.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.74
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,073.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL SOCKS
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905380016
|
|
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 CRANIAL SOCKS
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
915380016
|
|
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 CRANIAL SOCKS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
915380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| 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: 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 CRANIAL SOCKS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905380016
|
|
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 C-REACTIVE PROTEIN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California Commercial |
$63.00
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.87
|
| Rate for Payer: Blue Shield of California Commercial |
$51.66
|
| Rate for Payer: Blue Shield of California Commercial |
$198.45
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$125.06
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.95
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Senior |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC CREAM WOUND CARE ATRACTAIN 2OZ
|
Facility
|
IP
|
$27.88
|
|
| Hospital Charge Code |
901606201
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Adventist Health Commercial |
$5.58
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Central Health Plan Commercial |
$22.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.15
|
| Rate for Payer: EPIC Health Plan Senior |
$11.15
|
| Rate for Payer: Galaxy Health WC |
$23.70
|
| Rate for Payer: Global Benefits Group Commercial |
$16.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$20.91
|
| Rate for Payer: Networks By Design Commercial |
$18.12
|
| Rate for Payer: Prime Health Services Commercial |
$23.70
|
|
|
HC CREAM WOUND CARE ATRACTAIN 2OZ
|
Facility
|
OP
|
$27.88
|
|
| Hospital Charge Code |
901606201
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Adventist Health Commercial |
$5.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.22
|
| Rate for Payer: Blue Shield of California Commercial |
$17.68
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Central Health Plan Commercial |
$22.30
|
| Rate for Payer: Cigna of CA HMO |
$17.84
|
| Rate for Payer: Cigna of CA PPO |
$20.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.15
|
| Rate for Payer: EPIC Health Plan Senior |
$11.15
|
| Rate for Payer: Galaxy Health WC |
$23.70
|
| Rate for Payer: Global Benefits Group Commercial |
$16.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$20.91
|
| Rate for Payer: Networks By Design Commercial |
$18.12
|
| Rate for Payer: Prime Health Services Commercial |
$23.70
|
| Rate for Payer: Riverside University Health System MISP |
$11.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.94
|
| Rate for Payer: United Healthcare All Other HMO |
$13.94
|
| Rate for Payer: United Healthcare HMO Rider |
$13.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: Vantage Medical Group Senior |
$23.70
|
|
|
HC CREATINE KINASE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC CREATINE KINASE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.32
|
| Rate for Payer: Blue Shield of California Commercial |
$27.09
|
| Rate for Payer: Blue Shield of California Commercial |
$96.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.07
|
| Rate for Payer: Blue Shield of California EPN |
$60.74
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Prime Health Services Medicare |
$6.90
|
| Rate for Payer: Prime Health Services Medicare |
$6.90
|
| Rate for Payer: Riverside University Health System MISP |
$7.16
|
| Rate for Payer: Riverside University Health System MISP |
$7.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.27
|
| Rate for Payer: United Healthcare All Other HMO |
$5.27
|
| Rate for Payer: United Healthcare All Other HMO |
$5.27
|
| Rate for Payer: United Healthcare HMO Rider |
$5.27
|
| Rate for Payer: United Healthcare HMO Rider |
$5.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Senior |
$6.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6.51
|
|
