|
HC DLTR VESSEL 6FR
|
Facility
|
IP
|
$53.63
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$48.27 |
| Rate for Payer: Adventist Health Commercial |
$10.73
|
| Rate for Payer: Cash Price |
$24.13
|
| Rate for Payer: Central Health Plan Commercial |
$42.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Senior |
$21.45
|
| Rate for Payer: Galaxy Health WC |
$45.59
|
| Rate for Payer: Global Benefits Group Commercial |
$32.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$34.86
|
| Rate for Payer: Prime Health Services Commercial |
$45.59
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
OP
|
$53.63
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$48.27 |
| Rate for Payer: Adventist Health Commercial |
$10.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.20
|
| Rate for Payer: Blue Shield of California Commercial |
$34.00
|
| Rate for Payer: Blue Shield of California EPN |
$21.40
|
| Rate for Payer: Cash Price |
$24.13
|
| Rate for Payer: Central Health Plan Commercial |
$42.90
|
| Rate for Payer: Cigna of CA HMO |
$34.32
|
| Rate for Payer: Cigna of CA PPO |
$39.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Senior |
$21.45
|
| Rate for Payer: Galaxy Health WC |
$45.59
|
| Rate for Payer: Global Benefits Group Commercial |
$32.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.54
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$34.86
|
| Rate for Payer: Prime Health Services Commercial |
$45.59
|
| Rate for Payer: Riverside University Health System MISP |
$21.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.82
|
| Rate for Payer: United Healthcare All Other HMO |
$26.82
|
| Rate for Payer: United Healthcare HMO Rider |
$26.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.59
|
| Rate for Payer: Vantage Medical Group Senior |
$45.59
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
OP
|
$77.90
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.31
|
| Rate for Payer: Blue Shield of California Commercial |
$49.39
|
| Rate for Payer: Blue Shield of California EPN |
$31.08
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Central Health Plan Commercial |
$62.32
|
| Rate for Payer: Cigna of CA HMO |
$49.86
|
| Rate for Payer: Cigna of CA PPO |
$57.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.53
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| Rate for Payer: Networks By Design Commercial |
$50.63
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
| Rate for Payer: Riverside University Health System MISP |
$31.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.95
|
| Rate for Payer: United Healthcare All Other HMO |
$38.95
|
| Rate for Payer: United Healthcare HMO Rider |
$38.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.22
|
| Rate for Payer: Vantage Medical Group Senior |
$66.22
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
IP
|
$77.90
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Central Health Plan Commercial |
$62.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| Rate for Payer: Networks By Design Commercial |
$50.63
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$184.07 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,080.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,298.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,415.09
|
| Rate for Payer: Blue Shield of California EPN |
$890.57
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$810.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Riverside University Health System MISP |
$892.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$184.07 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,080.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,298.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,415.09
|
| Rate for Payer: Blue Shield of California EPN |
$890.57
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$810.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Riverside University Health System MISP |
$892.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.97
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$134.82
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Blue Shield of California EPN |
$84.96
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.67
|
| Rate for Payer: EPIC Health Plan Senior |
$15.11
|
| Rate for Payer: EPIC Health Plan Senior |
$15.11
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.74
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$14.56
|
| Rate for Payer: Prime Health Services Medicare |
$14.56
|
| Rate for Payer: Riverside University Health System MISP |
$15.11
|
| Rate for Payer: Riverside University Health System MISP |
$15.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC DOPPLER
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,266.20 |
| Rate for Payer: Adventist Health Commercial |
$503.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$996.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,063.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,464.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.34
|
| Rate for Payer: Blue Shield of California EPN |
$999.65
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,014.40
|
| Rate for Payer: Cigna of CA HMO |
$1,611.52
|
| Rate for Payer: Cigna of CA PPO |
$1,863.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,762.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$2,140.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,510.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,266.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$323.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,598.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,888.50
|
| Rate for Payer: Networks By Design Commercial |
$1,636.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,140.30
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,510.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,510.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DOPPLER
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$503.60 |
| Max. Negotiated Rate |
$2,266.20 |
| Rate for Payer: Adventist Health Commercial |
$503.60
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,014.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,762.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,007.20
|
| Rate for Payer: Galaxy Health WC |
$2,140.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,510.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,266.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,598.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,485.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.60
|
| Rate for Payer: Multiplan Commercial |
$1,888.50
|
| Rate for Payer: Networks By Design Commercial |
$1,636.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,140.30
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
905352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.54
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
915352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.54
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
915352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$216.54
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
905352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$216.54
|
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
915352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.95 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.26
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
915352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
905352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
905352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.95 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.26
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
908603026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.27
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California EPN |
$15.96
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Riverside University Health System MISP |
$16.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
908603026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890235
|
|
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 |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 DPT ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890235
|
|
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 |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| 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 DRAINABLE POUCH FLEX WIDE RED
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
