|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$1,297.69 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$40.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,297.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.37
|
| Rate for Payer: Blue Shield of California Commercial |
$79.52
|
| Rate for Payer: Blue Shield of California EPN |
$52.01
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$83.84
|
| Rate for Payer: Cigna of CA PPO |
$96.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.95
|
| Rate for Payer: EPIC Health Plan Senior |
$40.70
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$66.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.70
|
| Rate for Payer: InnovAge PACE Commercial |
$61.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40.70
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Prime Health Services Medicare |
$43.14
|
| Rate for Payer: Riverside University Health System MISP |
$44.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.97
|
| Rate for Payer: United Healthcare All Other HMO |
$32.97
|
| Rate for Payer: United Healthcare HMO Rider |
$32.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$40.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Vantage Medical Group Senior |
$40.70
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
IP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$346.96 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: Central Health Plan Commercial |
$308.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.20
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.10
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,234.22 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.49
|
| Rate for Payer: Blue Shield of California Commercial |
$219.73
|
| Rate for Payer: Blue Shield of California EPN |
$143.71
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$231.68
|
| Rate for Payer: Cigna of CA PPO |
$267.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Central Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Central Health Plan Commercial |
$381.60
|
| Rate for Payer: Cigna of CA HMO |
$305.28
|
| Rate for Payer: Cigna of CA PPO |
$352.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$384.21
|
| Rate for Payer: InnovAge PACE Commercial |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Riverside University Health System MISP |
$190.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$463.63
|
| 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 FIT & INSERT PESSARY SUPPORT D
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.31 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| 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 |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$407.27
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| 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 |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| 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: Heritage Provider Network Commercial/Senior |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$255.61
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$19,007.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,801.40 |
| Max. Negotiated Rate |
$17,106.30 |
| Rate for Payer: Adventist Health Commercial |
$3,801.40
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,205.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,602.80
|
| Rate for Payer: Galaxy Health WC |
$16,155.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,404.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,106.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,241.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,765.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,801.40
|
| Rate for Payer: Multiplan Commercial |
$14,255.25
|
| Rate for Payer: Networks By Design Commercial |
$12,354.55
|
| Rate for Payer: Prime Health Services Commercial |
$16,155.95
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$19,007.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,801.40 |
| Max. Negotiated Rate |
$17,106.30 |
| Rate for Payer: Adventist Health Commercial |
$3,801.40
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,205.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,602.80
|
| Rate for Payer: Galaxy Health WC |
$16,155.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,404.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,106.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,241.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,765.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,801.40
|
| Rate for Payer: Multiplan Commercial |
$14,255.25
|
| Rate for Payer: Networks By Design Commercial |
$12,354.55
|
| Rate for Payer: Prime Health Services Commercial |
$16,155.95
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$19,007.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$17,106.30 |
| Rate for Payer: Adventist Health Commercial |
$7,792.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,205.60
|
| Rate for Payer: Cigna of CA HMO |
$12,164.48
|
| Rate for Payer: Cigna of CA PPO |
$14,065.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$16,155.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,404.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,106.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,801.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$14,255.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$12,354.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$16,155.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,404.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$19,007.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$17,106.30 |
| Rate for Payer: Adventist Health Commercial |
$3,801.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,205.60
|
| Rate for Payer: Cigna of CA HMO |
$12,164.48
|
| Rate for Payer: Cigna of CA PPO |
$14,065.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$16,155.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,404.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,106.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,801.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$14,255.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$12,354.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$16,155.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,503.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,503.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,503.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,503.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Central Health Plan Commercial |
$168.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: EPIC Health Plan Senior |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.20
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$151.52
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$136.37 |
| Rate for Payer: Adventist Health Commercial |
$30.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.91
|
| Rate for Payer: Blue Shield of California Commercial |
$91.97
|
| Rate for Payer: Blue Shield of California EPN |
$60.15
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Central Health Plan Commercial |
$121.22
|
| Rate for Payer: Cigna of CA HMO |
$96.97
|
| Rate for Payer: Cigna of CA PPO |
$112.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Senior |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$128.79
|
| Rate for Payer: Global Benefits Group Commercial |
$90.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: InnovAge PACE Commercial |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$113.64
|
| Rate for Payer: Networks By Design Commercial |
$98.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$128.79
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
905356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.40 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$1,270.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,910.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,420.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$4,128.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
905356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,080.28 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$2,604.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,493.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,764.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,730.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,910.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,255.30
|
| Rate for Payer: InnovAge PACE Commercial |
$3,176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,446.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,446.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,540.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,399.20
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
915356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,080.28 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$2,604.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,493.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,764.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,730.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,910.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,255.30
|
| Rate for Payer: InnovAge PACE Commercial |
$3,176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,446.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,446.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,540.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,399.20
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
915356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.40 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$1,270.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,910.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,420.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$4,128.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
905356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.40 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$1,541.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,068.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,208.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,906.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,477.87
|
| Rate for Payer: InnovAge PACE Commercial |
$1,880.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,737.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,632.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,632.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,196.00
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
915356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,906.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
915356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.40 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$1,541.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,068.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,208.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,906.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,477.87
|
| Rate for Payer: InnovAge PACE Commercial |
$1,880.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,737.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,632.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,632.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,196.00
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
905356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,906.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
IP
|
$679.42
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Adventist Health Commercial |
$135.88
|
| Rate for Payer: Cash Price |
$305.74
|
| Rate for Payer: Central Health Plan Commercial |
$543.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.77
|
| Rate for Payer: EPIC Health Plan Senior |
$271.77
|
| Rate for Payer: Galaxy Health WC |
$577.51
|
| Rate for Payer: Global Benefits Group Commercial |
$407.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$611.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$453.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$420.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.88
|
| Rate for Payer: Multiplan Commercial |
$509.56
|
| Rate for Payer: Networks By Design Commercial |
$441.62
|
| Rate for Payer: Prime Health Services Commercial |
$577.51
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
OP
|
$679.42
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Adventist Health Commercial |
$135.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$577.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$509.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.02
|
| Rate for Payer: Blue Shield of California Commercial |
$415.13
|
| Rate for Payer: Blue Shield of California EPN |
$271.09
|
| Rate for Payer: Cash Price |
$305.74
|
| Rate for Payer: Central Health Plan Commercial |
$543.54
|
| Rate for Payer: Cigna of CA HMO |
$434.83
|
| Rate for Payer: Cigna of CA PPO |
$502.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$577.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$577.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$577.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.77
|
| Rate for Payer: EPIC Health Plan Senior |
$271.77
|
| Rate for Payer: Galaxy Health WC |
$577.51
|
| Rate for Payer: Global Benefits Group Commercial |
$407.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$611.48
|
| Rate for Payer: InnovAge PACE Commercial |
$339.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$453.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$420.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$475.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$475.59
|
| Rate for Payer: Multiplan Commercial |
$509.56
|
| Rate for Payer: Networks By Design Commercial |
$441.62
|
| Rate for Payer: Prime Health Services Commercial |
$577.51
|
| Rate for Payer: Riverside University Health System MISP |
$271.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.71
|
| Rate for Payer: United Healthcare All Other HMO |
$339.71
|
| Rate for Payer: United Healthcare HMO Rider |
$339.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$577.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$577.51
|
| Rate for Payer: Vantage Medical Group Senior |
$577.51
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
OP
|
$1,696.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,272.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,036.26
|
| Rate for Payer: Blue Shield of California EPN |
$676.70
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: InnovAge PACE Commercial |
$848.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,187.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,187.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Riverside University Health System MISP |
$678.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
IP
|
$1,696.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
