|
HC CULTURE YEAST RAPID ID
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$43.70
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE YERSINIA
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$10.01
|
| Rate for Payer: Riverside University Health System MISP |
$10.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.65
|
| Rate for Payer: United Healthcare HMO Rider |
$7.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC CULTURE YERSINIA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
905356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
905356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
905356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
905356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,014.45 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,612.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,777.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,075.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,521.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,460.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.20
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,998.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,014.45 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,612.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,777.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,075.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,521.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,460.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.20
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,998.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$244.98 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,469.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,969.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,388.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,484.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,622.73
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.98
|
| Rate for Payer: InnovAge PACE Commercial |
$2,033.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$244.98 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,469.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,969.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,388.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,484.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,622.73
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.98
|
| Rate for Payer: InnovAge PACE Commercial |
$2,033.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
|
HC CUSTOM SHOES, DEPTH INLAY(PR)
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT L3230
|
| Hospital Charge Code |
905353230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$294.15 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Adventist Health Commercial |
$867.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,163.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,242.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,635.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.46
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: Cigna of CA HMO |
$1,481.20
|
| Rate for Payer: Cigna of CA PPO |
$1,481.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,798.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,798.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.15
|
| Rate for Payer: InnovAge PACE Commercial |
$1,058.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$867.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,481.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,481.20
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Riverside University Health System MISP |
$846.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,269.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.13
|
| Rate for Payer: United Healthcare All Other HMO |
$772.97
|
| Rate for Payer: United Healthcare HMO Rider |
$756.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$692.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,798.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,798.60
|
|
|
HC CUSTOM SHOES, DEPTH INLAY(PR)
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT L3230
|
| Hospital Charge Code |
905353230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,635.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.46
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: Cigna of CA HMO |
$1,481.20
|
| Rate for Payer: Cigna of CA PPO |
$1,481.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$806.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.13
|
| Rate for Payer: United Healthcare All Other HMO |
$772.97
|
| Rate for Payer: United Healthcare HMO Rider |
$756.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$692.99
|
|
|
HC CUTTING BALLOON
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,166.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,440.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$929.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,127.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,173.12
|
| Rate for Payer: Blue Shield of California EPN |
$766.08
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,536.00
|
| Rate for Payer: Cigna of CA HMO |
$1,228.80
|
| Rate for Payer: Cigna of CA PPO |
$1,420.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,632.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$768.00
|
| Rate for Payer: Galaxy Health WC |
$1,632.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,728.00
|
| Rate for Payer: InnovAge PACE Commercial |
$960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,280.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,188.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$1,248.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,632.00
|
| Rate for Payer: Riverside University Health System MISP |
$768.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,152.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,152.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Other HMO |
$960.00
|
| Rate for Payer: United Healthcare HMO Rider |
$960.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,632.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,536.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$768.00
|
| Rate for Payer: Galaxy Health WC |
$1,632.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,280.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,188.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$1,248.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,632.00
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$917.10 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$618.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$493.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.46
|
| Rate for Payer: Blue Shield of California Commercial |
$622.61
|
| Rate for Payer: Blue Shield of California EPN |
$406.58
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Central Health Plan Commercial |
$815.20
|
| Rate for Payer: Cigna of CA HMO |
$652.16
|
| Rate for Payer: Cigna of CA PPO |
$754.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$866.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$917.10
|
| Rate for Payer: InnovAge PACE Commercial |
$509.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$630.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$713.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$713.30
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
| Rate for Payer: Riverside University Health System MISP |
$407.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.50
|
| Rate for Payer: United Healthcare All Other HMO |
$509.50
|
| Rate for Payer: United Healthcare HMO Rider |
$509.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$917.10 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Central Health Plan Commercial |
$815.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$917.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$630.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
|
