|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
OP
|
$8,829.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,765.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,063.20
|
| Rate for Payer: Cigna of CA HMO |
$5,650.56
|
| Rate for Payer: Cigna of CA PPO |
$6,533.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,180.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,504.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,297.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,946.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,606.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$446.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,765.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,621.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,738.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,504.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,297.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,414.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,414.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,414.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,414.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
OP
|
$10,830.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: Cigna of CA HMO |
$6,931.20
|
| Rate for Payer: Cigna of CA PPO |
$8,014.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,877.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$884.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,415.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
IP
|
$10,830.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,166.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,332.00
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,877.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,389.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,137.20 |
| Max. Negotiated Rate |
$18,617.40 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,480.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,274.40
|
| Rate for Payer: Galaxy Health WC |
$17,583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$12,411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,617.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,135.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,204.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: Networks By Design Commercial |
$13,445.90
|
| Rate for Payer: Prime Health Services Commercial |
$17,583.10
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,514.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,548.80
|
| Rate for Payer: Cigna of CA HMO |
$13,239.04
|
| Rate for Payer: Cigna of CA PPO |
$15,307.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,583.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,583.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,480.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,274.40
|
| Rate for Payer: Galaxy Health WC |
$17,583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$12,411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,617.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,135.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,204.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,137.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,480.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: Networks By Design Commercial |
$13,445.90
|
| Rate for Payer: Prime Health Services Commercial |
$17,583.10
|
| Rate for Payer: Riverside University Health System MISP |
$8,274.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,411.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,343.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$17,583.10
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$554.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$342.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.27
|
| Rate for Payer: Blue Shield of California Commercial |
$410.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$554.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$554.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$554.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$384.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$456.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Riverside University Health System MISP |
$260.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$554.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$554.20
|
| Rate for Payer: Vantage Medical Group Senior |
$554.20
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$384.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.27
|
| Rate for Payer: Blue Shield of California Commercial |
$410.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$384.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$384.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.27
|
| Rate for Payer: Blue Shield of California Commercial |
$410.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$384.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.27
|
| Rate for Payer: Blue Shield of California Commercial |
$410.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$384.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.27
|
| Rate for Payer: Blue Shield of California Commercial |
$410.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$456.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$362.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.69
|
| Rate for Payer: Blue Shield of California Commercial |
$474.87
|
| Rate for Payer: Blue Shield of California EPN |
$298.85
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: Cigna of CA HMO |
$479.36
|
| Rate for Payer: Cigna of CA PPO |
$554.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$636.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$524.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Senior |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$475.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$441.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$524.30
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
| Rate for Payer: Riverside University Health System MISP |
$299.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$449.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$449.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$374.50
|
| Rate for Payer: United Healthcare All Other HMO |
$374.50
|
| Rate for Payer: United Healthcare HMO Rider |
$374.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$524.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Senior |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$475.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$441.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.29
|
| Rate for Payer: Blue Shield of California Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Riverside University Health System MISP |
$72.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Blue Shield of California Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.29
|
| Rate for Payer: Blue Shield of California Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Riverside University Health System MISP |
$72.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Blue Shield of California Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Central Health Plan Commercial |
$706.40
|
| Rate for Payer: Cigna of CA HMO |
$565.12
|
| Rate for Payer: Cigna of CA PPO |
$653.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$618.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$750.55
|
| Rate for Payer: Global Benefits Group Commercial |
$529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$573.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$750.55
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.50
|
| Rate for Payer: United Healthcare All Other HMO |
$441.50
|
| Rate for Payer: United Healthcare HMO Rider |
$441.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$794.70 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Central Health Plan Commercial |
$706.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$618.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$353.20
|
| Rate for Payer: Galaxy Health WC |
$750.55
|
| Rate for Payer: Global Benefits Group Commercial |
$529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.60
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Networks By Design Commercial |
$573.95
|
| Rate for Payer: Prime Health Services Commercial |
$750.55
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$9,613.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,922.60 |
| Max. Negotiated Rate |
$8,651.70 |
| Rate for Payer: Adventist Health Commercial |
$1,922.60
|
| Rate for Payer: Cash Price |
$4,325.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,690.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,729.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,845.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,845.20
|
| Rate for Payer: Galaxy Health WC |
$8,171.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,767.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,651.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,104.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,671.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.60
|
| Rate for Payer: Multiplan Commercial |
$7,209.75
|
| Rate for Payer: Networks By Design Commercial |
$6,248.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,171.05
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$9,613.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$11,690.00 |
| Rate for Payer: Adventist Health Commercial |
$1,922.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,690.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,094.64
|
| Rate for Payer: Blue Shield of California EPN |
$3,835.59
|
| Rate for Payer: Cash Price |
$4,325.85
|
| Rate for Payer: Cash Price |
$4,325.85
|
| Rate for Payer: Cash Price |
$4,325.85
|
| Rate for Payer: Cash Price |
$4,325.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,690.40
|
| Rate for Payer: Cigna of CA HMO |
$6,152.32
|
| Rate for Payer: Cigna of CA PPO |
$7,113.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,729.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$8,171.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,767.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,651.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,104.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$7,209.75
|
| Rate for Payer: Networks By Design Commercial |
$6,248.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Prime Health Services Commercial |
$8,171.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,767.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,767.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
