|
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 |
$204.87
|
| Rate for Payer: Blue Shield of California Commercial |
$286.01
|
| Rate for Payer: Blue Shield of California EPN |
$186.48
|
| Rate for Payer: Cash Price |
$203.50
|
| 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: 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: InnovAge PACE Commercial |
$185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$286.01
|
| Rate for Payer: Blue Shield of California EPN |
$186.48
|
| Rate for Payer: Cash Price |
$203.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.03
|
| 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 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 |
$135.28
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$96.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| 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 |
$102.78
|
| Rate for Payer: Blue Shield of California Commercial |
$135.28
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$96.25
|
| 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: 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: InnovAge PACE Commercial |
$87.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
900910423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
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 |
$76.99 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| 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 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 HMO/PPO |
$15.63
|
| Rate for Payer: Blue Shield of California Commercial |
$42.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.26
|
| Rate for Payer: EPIC Health Plan Senior |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| 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) Medicare Advantage |
$10.56
|
| Rate for Payer: InnovAge PACE Commercial |
$15.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.56
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Medicare |
$11.19
|
| Rate for Payer: Riverside University Health System MISP |
$11.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| 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 HMO |
$8.55
|
| Rate for Payer: United Healthcare HMO Rider |
$8.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.55
|
| 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 Medi-Cal |
$11.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
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 |
$251.22
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$178.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| 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 |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$251.22
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$178.75
|
| 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: 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: InnovAge PACE Commercial |
$162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$251.22
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$178.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| 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 |
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 |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$251.22
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$178.75
|
| 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: 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: InnovAge PACE Commercial |
$162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| 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 |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| 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: 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: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| 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: 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: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| 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 COMPUTER/DYNAMIC POSTUROGRAPHY
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
905101073
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.00
|
| Rate for Payer: EPIC Health Plan Senior |
$190.00
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
905101073
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.97
|
| Rate for Payer: Blue Shield of California Commercial |
$288.32
|
| Rate for Payer: Blue Shield of California EPN |
$188.57
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: Cigna of CA HMO |
$304.00
|
| Rate for Payer: Cigna of CA PPO |
$351.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY COMM MCARE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
900411039
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.00
|
| Rate for Payer: EPIC Health Plan Senior |
$190.00
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY COMM MCARE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
900411039
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.97
|
| Rate for Payer: Blue Shield of California Commercial |
$288.32
|
| Rate for Payer: Blue Shield of California EPN |
$188.57
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: Cigna of CA HMO |
$304.00
|
| Rate for Payer: Cigna of CA PPO |
$351.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC COMVAX ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890226
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC COMVAX ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890226
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906820097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,235.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,924.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,345.60
|
| Rate for Payer: Cigna of CA HMO |
$4,343.30
|
| Rate for Payer: Cigna of CA PPO |
$4,944.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,013.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
IP
|
$5,680.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906811595
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,136.00 |
| Max. Negotiated Rate |
$5,112.00 |
| Rate for Payer: Adventist Health Commercial |
$1,136.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,272.00
|
| Rate for Payer: Galaxy Health WC |
$4,828.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,112.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,788.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,164.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,515.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.00
|
| Rate for Payer: Multiplan Commercial |
$4,260.00
|
| Rate for Payer: Networks By Design Commercial |
$3,692.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,828.00
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
OP
|
$5,680.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906811595
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,136.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,750.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,335.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,544.00
|
| Rate for Payer: Cigna of CA HMO |
$3,692.00
|
| Rate for Payer: Cigna of CA PPO |
$4,203.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$4,828.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,112.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,788.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$4,260.00
|
| Rate for Payer: Networks By Design Commercial |
$3,692.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,828.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906820097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$6,013.80 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,345.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,672.80
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,545.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,136.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.40
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
|
|
HC CONG R & L HEART W SEPTAL
|
Facility
|
OP
|
$7,338.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,467.60 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,467.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,237.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,035.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,503.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,553.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,309.61
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,035.90
|
| Rate for Payer: Cash Price |
$4,035.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,870.40
|
| Rate for Payer: Cigna of CA HMO |
$4,769.70
|
| Rate for Payer: Cigna of CA PPO |
$5,430.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,237.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,237.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,935.20
|
| Rate for Payer: Galaxy Health WC |
$6,237.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,604.20
|
| Rate for Payer: InnovAge PACE Commercial |
$3,669.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,894.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,795.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,542.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,136.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,136.60
|
| Rate for Payer: Multiplan Commercial |
$5,503.50
|
| Rate for Payer: Networks By Design Commercial |
$4,769.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,237.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,935.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,402.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,669.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,669.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,669.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,237.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,237.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,237.30
|
|
