|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
915353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.69
|
| Rate for Payer: Blue Shield of California Commercial |
$109.87
|
| Rate for Payer: Blue Shield of California EPN |
$69.05
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.69
|
| Rate for Payer: Blue Shield of California Commercial |
$109.87
|
| Rate for Payer: Blue Shield of California EPN |
$69.05
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.87
|
| Rate for Payer: Blue Shield of California EPN |
$69.05
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
915353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$384.96
|
| Rate for Payer: Blue Shield of California EPN |
$241.92
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
915353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.22
|
| Rate for Payer: Blue Shield of California Commercial |
$384.96
|
| Rate for Payer: Blue Shield of California EPN |
$241.92
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Riverside University Health System MISP |
$192.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$384.96
|
| Rate for Payer: Blue Shield of California EPN |
$241.92
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.22
|
| Rate for Payer: Blue Shield of California Commercial |
$384.96
|
| Rate for Payer: Blue Shield of California EPN |
$241.92
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Riverside University Health System MISP |
$192.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC HFO WO JOINT PF
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.57
|
| Rate for Payer: Blue Shield of California Commercial |
$211.73
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO WO JOINT PF
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$211.73
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
915353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
915353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.59
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.59
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$324.81
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
915355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,529.47 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$5,244.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,441.11
|
| Rate for Payer: Blue Shield of California Commercial |
$10,259.18
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,873.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,529.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,547.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,244.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,954.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,529.47 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$5,244.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,441.11
|
| Rate for Payer: Blue Shield of California Commercial |
$10,259.18
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,873.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,529.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,547.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,244.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,954.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$2,558.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10,259.18
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,547.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$8,314.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
915355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$2,558.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10,259.18
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,547.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$8,314.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
|
|
HC HIGH FLOW 02
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.40
|
| Rate for Payer: Blue Shield of California Commercial |
$296.10
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC HIGH FLOW 02
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
OP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$794.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: Cigna of CA HMO |
$6,711.04
|
| Rate for Payer: Cigna of CA PPO |
$7,759.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,658.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$794.58
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
| Rate for Payer: Prime Health Services Medicare |
$842.25
|
| Rate for Payer: Riverside University Health System MISP |
$874.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
IP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,097.20 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,194.40
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,658.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,186.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,669.60 |
| Max. Negotiated Rate |
$7,513.20 |
| Rate for Payer: Adventist Health Commercial |
$1,669.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,678.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,843.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,339.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,339.20
|
| Rate for Payer: Galaxy Health WC |
$7,095.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,008.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,513.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,300.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,925.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.60
|
| Rate for Payer: Multiplan Commercial |
$6,261.00
|
| Rate for Payer: Networks By Design Commercial |
$5,426.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,095.80
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$7,513.20 |
| Rate for Payer: Adventist Health Commercial |
$1,669.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$794.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,678.40
|
| Rate for Payer: Cigna of CA HMO |
$5,342.72
|
| Rate for Payer: Cigna of CA PPO |
$6,177.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,843.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| Rate for Payer: Galaxy Health WC |
$7,095.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,008.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,513.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,300.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$6,261.00
|
| Rate for Payer: Networks By Design Commercial |
$5,426.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$794.58
|
| Rate for Payer: Prime Health Services Commercial |
$7,095.80
|
| Rate for Payer: Prime Health Services Medicare |
$842.25
|
| Rate for Payer: Riverside University Health System MISP |
$874.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,008.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,008.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
915352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Blue Shield of California Commercial |
$547.77
|
| Rate for Payer: Blue Shield of California EPN |
$344.23
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.60
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$443.95
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
915352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.68 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Adventist Health Commercial |
$280.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$512.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.30
|
| Rate for Payer: Blue Shield of California Commercial |
$547.77
|
| Rate for Payer: Blue Shield of California EPN |
$344.23
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$580.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$580.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$580.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$478.10
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Riverside University Health System MISP |
$273.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$580.55
|
| Rate for Payer: Vantage Medical Group Senior |
$580.55
|
|
