|
HC HAST W/02 TITRATE
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$255.00
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$892.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.00
|
| Rate for Payer: EPIC Health Plan Senior |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,147.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$809.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$752.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$956.25
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$255.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$384.09
|
| 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 |
$382.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$741.67
|
| Rate for Payer: Blue Shield of California Commercial |
$803.25
|
| Rate for Payer: Blue Shield of California EPN |
$506.18
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.00
|
| Rate for Payer: Cigna of CA HMO |
$816.00
|
| Rate for Payer: Cigna of CA PPO |
$943.50
|
| 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 |
$892.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,147.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$809.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$462.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$956.25
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
| 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 |
$765.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| 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 HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC HCV RNA QUANT
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$405.09
|
| Rate for Payer: Blue Shield of California Commercial |
$142.38
|
| Rate for Payer: Blue Shield of California EPN |
$255.27
|
| Rate for Payer: Blue Shield of California EPN |
$89.72
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$100.80
|
| Rate for Payer: Blue Shield of California Commercial |
$88.20
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.60
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$2,075.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$966.98 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,857.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$966.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,277.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.60
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$2,075.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$966.98 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,857.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$966.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,277.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$918.81 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Adventist Health Commercial |
$2,215.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,052.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4,333.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,723.11
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,592.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$918.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,215.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,782.10
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,161.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,333.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,723.11
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.60
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
915355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,333.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,723.11
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.60
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
915355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$918.81 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: Adventist Health Commercial |
$2,215.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,052.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4,333.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,723.11
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,592.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$918.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,215.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,782.10
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,161.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$834.14 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,042.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,283.69
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,186.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,042.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,283.69
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.40
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,655.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$834.14 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,042.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,283.69
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,186.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,042.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,283.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.40
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,655.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,159.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.60
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,750.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,159.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.60
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,750.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.96 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$1,104.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,566.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,159.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,119.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,885.10
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,077.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.96 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: Adventist Health Commercial |
$1,104.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,566.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,159.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,119.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,885.10
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,077.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.88 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Adventist Health Commercial |
$336.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.58
|
| Rate for Payer: Blue Shield of California Commercial |
$658.44
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Riverside University Health System MISP |
$328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
915355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.88 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Adventist Health Commercial |
$336.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.58
|
| Rate for Payer: Blue Shield of California Commercial |
$658.44
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Riverside University Health System MISP |
$328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Blue Shield of California Commercial |
$658.44
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.20
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
|
