|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$2.73
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
| Rate for Payer: Riverside University Health System MISP |
$1.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.13
|
| Rate for Payer: United Healthcare All Other HMO |
$2.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Vantage Medical Group Senior |
$3.63
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
915350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.44
|
| Rate for Payer: Blue Shield of California Commercial |
$112.28
|
| Rate for Payer: Blue Shield of California EPN |
$70.56
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Riverside University Health System MISP |
$56.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
915350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.28
|
| Rate for Payer: Blue Shield of California EPN |
$70.56
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.28
|
| Rate for Payer: Blue Shield of California EPN |
$70.56
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.44
|
| Rate for Payer: Blue Shield of California Commercial |
$112.28
|
| Rate for Payer: Blue Shield of California EPN |
$70.56
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Riverside University Health System MISP |
$56.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
905352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
915352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
905352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.54 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
915352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.54 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.70
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$462.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$510.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
915350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.53 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.01
|
| Rate for Payer: Blue Shield of California Commercial |
$569.42
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Riverside University Health System MISP |
$284.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
915350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Blue Shield of California Commercial |
$569.42
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
905350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Blue Shield of California Commercial |
$569.42
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC LO SAGITT RIGID PANEL PREFAB
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L0627
|
| Hospital Charge Code |
905350627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.53 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.01
|
| Rate for Payer: Blue Shield of California Commercial |
$569.42
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Riverside University Health System MISP |
$284.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
915350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Blue Shield of California Commercial |
$152.38
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
OP
|
$9,608.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
905350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$8,647.20 |
| Rate for Payer: Adventist Health Commercial |
$3,939.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,284.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,206.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,588.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7,705.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,842.43
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,686.40
|
| Rate for Payer: Cigna of CA HMO |
$6,725.60
|
| Rate for Payer: Cigna of CA PPO |
$6,725.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,166.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,166.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,843.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,843.20
|
| Rate for Payer: Galaxy Health WC |
$8,166.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,647.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,101.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,668.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,939.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,725.60
|
| Rate for Payer: Multiplan Commercial |
$7,206.00
|
| Rate for Payer: Networks By Design Commercial |
$4,804.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,166.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,843.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,764.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,764.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,605.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,509.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3,433.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,146.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,166.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,166.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,166.80
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
915350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.52
|
| Rate for Payer: Blue Shield of California Commercial |
$152.38
|
| Rate for Payer: Blue Shield of California EPN |
$95.76
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$133.00
|
| Rate for Payer: Cigna of CA PPO |
$133.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$161.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$95.00
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Riverside University Health System MISP |
$76.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.31
|
| Rate for Payer: United Healthcare All Other HMO |
$69.41
|
| Rate for Payer: United Healthcare HMO Rider |
$67.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.50
|
| Rate for Payer: Vantage Medical Group Senior |
$161.50
|
|
|
HC LO SAG STAYS/PANELS PRE-FAB
|
Facility
|
IP
|
$9,608.00
|
|
|
Service Code
|
CPT L0626
|
| Hospital Charge Code |
905350626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,921.60 |
| Max. Negotiated Rate |
$8,647.20 |
| Rate for Payer: Adventist Health Commercial |
$1,921.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,705.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,842.43
|
| Rate for Payer: Cash Price |
$4,323.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,686.40
|
| Rate for Payer: Cigna of CA HMO |
$6,725.60
|
| Rate for Payer: Cigna of CA PPO |
$6,725.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,843.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,843.20
|
| Rate for Payer: Galaxy Health WC |
$8,166.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,647.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,101.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,668.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.60
|
| Rate for Payer: Multiplan Commercial |
$7,206.00
|
| Rate for Payer: Networks By Design Commercial |
$6,245.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,605.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,509.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3,433.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,146.62
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 100 SQCM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
900101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,331.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,205.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,644.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,275.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,389.73
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,863.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,863.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,534.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Riverside University Health System MISP |
$876.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,863.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,863.20
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 100 SQCM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
900101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 25 SQCM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
900101513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.85 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,205.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,644.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,275.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,389.73
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,863.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,863.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,534.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Riverside University Health System MISP |
$876.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,863.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,863.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,863.20
|
|
|
HC LOW COST SKIN SUB F/S/N/G/H/F 1ST 25 SQCM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
900101513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
