|
HC FO SAFETY PIN WIRE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309135
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.08
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
|
|
HC FO SAFETY PIN WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309135
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.16
|
| Rate for Payer: Blue Shield of California Commercial |
$112.08
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$72.50
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Riverside University Health System MISP |
$58.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC FO W/O JOINTS CF
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT L3933
|
| Hospital Charge Code |
905353933
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$131.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.94
|
| Rate for Payer: Blue Shield of California Commercial |
$247.36
|
| Rate for Payer: Blue Shield of California EPN |
$161.28
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$224.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$209.94
|
| Rate for Payer: InnovAge PACE Commercial |
$160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$160.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Riverside University Health System MISP |
$128.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.10
|
| Rate for Payer: United Healthcare All Other HMO |
$116.90
|
| Rate for Payer: United Healthcare HMO Rider |
$114.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC FO W/O JOINTS CF
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT L3933
|
| Hospital Charge Code |
905353933
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Blue Shield of California Commercial |
$247.36
|
| Rate for Payer: Blue Shield of California EPN |
$161.28
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.10
|
| Rate for Payer: United Healthcare All Other HMO |
$116.90
|
| Rate for Payer: United Healthcare HMO Rider |
$114.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.80
|
|
|
HC FRACTIONAL O2 SATUR (BG POC)
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 82810
|
| Hospital Charge Code |
900912230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
HC FRACTIONAL O2 SATUR (BG POC)
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 82810
|
| Hospital Charge Code |
900912230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.88
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$7.54
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.19
|
| Rate for Payer: EPIC Health Plan Senior |
$9.77
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.77
|
| Rate for Payer: InnovAge PACE Commercial |
$14.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.77
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Medicare |
$10.36
|
| Rate for Payer: Riverside University Health System MISP |
$10.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
HC FREE T4 BY EIA
|
Facility
|
IP
|
$92.05
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Adventist Health Commercial |
$18.41
|
| Rate for Payer: Cash Price |
$50.63
|
| Rate for Payer: Central Health Plan Commercial |
$73.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.82
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$78.24
|
| Rate for Payer: Global Benefits Group Commercial |
$55.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$69.04
|
| Rate for Payer: Networks By Design Commercial |
$59.83
|
| Rate for Payer: Prime Health Services Commercial |
$78.24
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$92.05
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Adventist Health Commercial |
$18.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.31
|
| Rate for Payer: Blue Shield of California Commercial |
$55.87
|
| Rate for Payer: Blue Shield of California EPN |
$36.54
|
| Rate for Payer: Cash Price |
$50.63
|
| Rate for Payer: Cash Price |
$50.63
|
| Rate for Payer: Central Health Plan Commercial |
$73.64
|
| Rate for Payer: Cigna of CA HMO |
$58.91
|
| Rate for Payer: Cigna of CA PPO |
$68.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$78.24
|
| Rate for Payer: Global Benefits Group Commercial |
$55.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: InnovAge PACE Commercial |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$69.04
|
| Rate for Payer: Networks By Design Commercial |
$59.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.02
|
| Rate for Payer: Prime Health Services Commercial |
$78.24
|
| Rate for Payer: Prime Health Services Medicare |
$9.56
|
| Rate for Payer: Riverside University Health System MISP |
$9.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FRICTION ARM SUPPORT
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
CPT L3968
|
| Hospital Charge Code |
903203968
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$292.20 |
| Max. Negotiated Rate |
$1,314.90 |
| Rate for Payer: Adventist Health Commercial |
$292.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$887.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,241.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$803.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,095.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$707.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$858.05
|
| Rate for Payer: Blue Shield of California Commercial |
$892.67
|
| Rate for Payer: Blue Shield of California EPN |
$582.94
|
| Rate for Payer: Cash Price |
$803.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,168.80
|
| Rate for Payer: Cigna of CA HMO |
$935.04
|
| Rate for Payer: Cigna of CA PPO |
$1,081.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,241.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,241.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,241.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.40
|
| Rate for Payer: EPIC Health Plan Senior |
$584.40
|
| Rate for Payer: Galaxy Health WC |
$1,241.85
|
| Rate for Payer: Global Benefits Group Commercial |
$876.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,314.90
|
| Rate for Payer: InnovAge PACE Commercial |
$730.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$974.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$904.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,022.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,022.70
|
| Rate for Payer: Multiplan Commercial |
$1,095.75
|
| Rate for Payer: Networks By Design Commercial |
$949.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,241.85
|
| Rate for Payer: Riverside University Health System MISP |
$584.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$876.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$876.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$730.50
|
| Rate for Payer: United Healthcare All Other HMO |
$730.50
|
| Rate for Payer: United Healthcare HMO Rider |
$730.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$730.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,241.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,241.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,241.85
|
|
|
HC FRICTION ARM SUPPORT
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
CPT L3968
|
| Hospital Charge Code |
903203968
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$292.20 |
| Max. Negotiated Rate |
$1,314.90 |
| Rate for Payer: Adventist Health Commercial |
$292.20
|
| Rate for Payer: Cash Price |
$803.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,168.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.40
|
| Rate for Payer: EPIC Health Plan Senior |
$584.40
|
| Rate for Payer: Galaxy Health WC |
$1,241.85
|
| Rate for Payer: Global Benefits Group Commercial |
$876.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,314.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$974.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$904.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.20
|
| Rate for Payer: Multiplan Commercial |
$1,095.75
|
| Rate for Payer: Networks By Design Commercial |
$949.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,241.85
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$103.19
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC FSH
|
Facility
|
IP
|
$148.72
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$133.85 |
| Rate for Payer: Adventist Health Commercial |
$29.74
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Central Health Plan Commercial |
$118.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.49
|
| Rate for Payer: EPIC Health Plan Senior |
$59.49
|
| Rate for Payer: Galaxy Health WC |
$126.41
|
| Rate for Payer: Global Benefits Group Commercial |
$89.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.74
|
| Rate for Payer: Multiplan Commercial |
$111.54
|
| Rate for Payer: Networks By Design Commercial |
$96.67
|
| Rate for Payer: Prime Health Services Commercial |
$126.41
|
|
|
HC FSH
|
Facility
|
OP
|
$148.72
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$135.18 |
| Rate for Payer: Adventist Health Commercial |
$29.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.43
|
| Rate for Payer: Blue Shield of California Commercial |
$90.27
|
| Rate for Payer: Blue Shield of California EPN |
$59.04
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Central Health Plan Commercial |
$118.98
|
| Rate for Payer: Cigna of CA HMO |
$95.18
|
| Rate for Payer: Cigna of CA PPO |
$110.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.08
|
| Rate for Payer: EPIC Health Plan Senior |
$18.58
|
| Rate for Payer: Galaxy Health WC |
$126.41
|
| Rate for Payer: Global Benefits Group Commercial |
$89.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: InnovAge PACE Commercial |
$27.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$111.54
|
| Rate for Payer: Networks By Design Commercial |
$96.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.58
|
| Rate for Payer: Prime Health Services Commercial |
$126.41
|
| Rate for Payer: Prime Health Services Medicare |
$19.69
|
| Rate for Payer: Riverside University Health System MISP |
$20.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO |
$15.05
|
| Rate for Payer: United Healthcare HMO Rider |
$15.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,307.36 |
| Max. Negotiated Rate |
$7,128.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,651.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6,122.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,991.68
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,336.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,128.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,307.36
|
| Rate for Payer: InnovAge PACE Commercial |
$3,960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$5,940.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,307.36 |
| Max. Negotiated Rate |
$7,128.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,651.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6,122.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,991.68
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,336.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,128.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,307.36
|
| Rate for Payer: InnovAge PACE Commercial |
$3,960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$5,940.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$7,128.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,122.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,991.68
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,336.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,128.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$5,940.00
|
| Rate for Payer: Networks By Design Commercial |
$5,148.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$7,128.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,122.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,991.68
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,336.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,128.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$5,940.00
|
| Rate for Payer: Networks By Design Commercial |
$5,148.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FULL DAY ADOL/CHILD
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
907803300
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Cash Price |
$471.35
|
| Rate for Payer: Central Health Plan Commercial |
$685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$342.80
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$771.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$530.48
|
| Rate for Payer: Multiplan Commercial |
$642.75
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
|
|
HC FULL DAY ADOL/CHILD
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
907803300
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$414.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.32
|
| Rate for Payer: Blue Shield of California Commercial |
$523.63
|
| Rate for Payer: Blue Shield of California EPN |
$341.94
|
| Rate for Payer: Cash Price |
$471.35
|
| Rate for Payer: Cash Price |
$471.35
|
| Rate for Payer: Cash Price |
$471.35
|
| Rate for Payer: Central Health Plan Commercial |
$685.60
|
| Rate for Payer: Cigna of CA HMO |
$548.48
|
| Rate for Payer: Cigna of CA PPO |
$634.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$771.30
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$642.75
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC FULL DAY ADOL EATING DISORDER
|
Facility
|
OP
|
$1,837.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
907803315
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$1,653.30 |
| Rate for Payer: Adventist Health Commercial |
$367.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,115.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,078.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,122.41
|
| Rate for Payer: Blue Shield of California EPN |
$732.96
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,469.60
|
| Rate for Payer: Cigna of CA HMO |
$1,175.68
|
| Rate for Payer: Cigna of CA PPO |
$1,359.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$1,561.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,102.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,653.30
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,225.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$1,377.75
|
| Rate for Payer: Networks By Design Commercial |
$1,194.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,561.45
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,102.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,102.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$918.50
|
| Rate for Payer: United Healthcare All Other HMO |
$918.50
|
| Rate for Payer: United Healthcare HMO Rider |
$918.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$918.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC FULL DAY ADOL EATING DISORDER
|
Facility
|
IP
|
$1,837.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
907803315
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$367.40 |
| Max. Negotiated Rate |
$1,653.30 |
| Rate for Payer: Adventist Health Commercial |
$367.40
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,469.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$734.80
|
| Rate for Payer: EPIC Health Plan Senior |
$734.80
|
| Rate for Payer: Galaxy Health WC |
$1,561.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,102.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,653.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,225.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,137.10
|
| Rate for Payer: Multiplan Commercial |
$1,377.75
|
| Rate for Payer: Networks By Design Commercial |
$1,194.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,561.45
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.86
|
| Rate for Payer: InnovAge PACE Commercial |
$55.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.86
|
| Rate for Payer: InnovAge PACE Commercial |
$55.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
