|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$1,308.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Distinction Transplant |
$872.40
|
| Rate for Payer: Blue Shield of California Commercial |
$898.57
|
| Rate for Payer: Blue Shield of California EPN |
$706.64
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,163.20
|
| Rate for Payer: Cigna of CA HMO |
$930.56
|
| Rate for Payer: Cigna of CA PPO |
$1,075.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,235.90
|
| Rate for Payer: Global Benefits Group Commercial |
$872.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,308.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,090.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$969.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,090.50
|
| Rate for Payer: Networks By Design Commercial |
$945.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,235.90
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$872.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$872.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.80 |
| Max. Negotiated Rate |
$1,308.60 |
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.60
|
| Rate for Payer: Galaxy Health WC |
$1,235.90
|
| Rate for Payer: Global Benefits Group Commercial |
$872.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,308.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$969.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.80
|
| Rate for Payer: Multiplan Commercial |
$1,090.50
|
| Rate for Payer: Networks By Design Commercial |
$945.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,235.90
|
|
|
HC HAPTOGLOBIN
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$111.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.59
|
| Rate for Payer: Blue Distinction Transplant |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29.66
|
| Rate for Payer: Blue Shield of California EPN |
$23.33
|
| Rate for Payer: Caremore Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Media |
$12.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.58
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: InnovAge PACE Commercial |
$18.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Medicare |
$13.33
|
| Rate for Payer: Riverside University Health System MISP |
$13.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HAPTOGLOBIN
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| 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
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$408.60
|
| Rate for Payer: Blue Shield of California Commercial |
$420.86
|
| Rate for Payer: Blue Shield of California EPN |
$330.97
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: Cigna of CA HMO |
$435.84
|
| Rate for Payer: Cigna of CA PPO |
$503.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$510.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.50
|
| Rate for Payer: United Healthcare All Other HMO |
$340.50
|
| Rate for Payer: United Healthcare HMO Rider |
$340.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
911800304
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$408.60
|
| Rate for Payer: Blue Shield of California Commercial |
$428.35
|
| Rate for Payer: Blue Shield of California EPN |
$333.01
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: Cigna of CA HMO |
$435.84
|
| Rate for Payer: Cigna of CA PPO |
$503.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$510.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.40
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
911800304
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.40
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
|
|
HC HARVEST THAW W/WASHING
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 38209
|
| Hospital Charge Code |
911800305
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC HARVEST THAW W/WASHING
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 38209
|
| Hospital Charge Code |
911800305
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$795.68
|
| Rate for Payer: Blue Shield of California EPN |
$618.58
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$948.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC HAST
|
Facility
|
IP
|
$1,143.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$228.60 |
| Max. Negotiated Rate |
$1,028.70 |
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Central Health Plan Commercial |
$914.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$457.20
|
| Rate for Payer: Galaxy Health WC |
$971.55
|
| Rate for Payer: Global Benefits Group Commercial |
$685.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,028.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$762.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.60
|
| Rate for Payer: Multiplan Commercial |
$857.25
|
| Rate for Payer: Networks By Design Commercial |
$742.95
|
| Rate for Payer: Prime Health Services Commercial |
$971.55
|
|
|
HC HAST
|
Facility
|
OP
|
$1,143.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$1,028.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$675.28
|
| Rate for Payer: Blue Distinction Transplant |
$685.80
|
| Rate for Payer: Blue Shield of California Commercial |
$706.37
|
| Rate for Payer: Blue Shield of California EPN |
$555.50
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Central Health Plan Commercial |
$914.40
|
| Rate for Payer: Cigna of CA HMO |
$731.52
|
| Rate for Payer: Cigna of CA PPO |
$845.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$971.55
|
| Rate for Payer: Global Benefits Group Commercial |
$685.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,028.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$857.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$762.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$857.25
|
| Rate for Payer: Networks By Design Commercial |
$742.95
|
| Rate for Payer: Prime Health Services Commercial |
$971.55
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$685.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$685.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$966.60 |
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$966.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$382.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$634.52
|
| Rate for Payer: Blue Distinction Transplant |
$644.40
|
| Rate for Payer: Blue Shield of California Commercial |
$663.73
|
| Rate for Payer: Blue Shield of California EPN |
$521.96
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: Cigna of CA HMO |
$687.36
|
| Rate for Payer: Cigna of CA PPO |
$794.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$805.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$644.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC HCV RNA QUANT
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.58
|
| Rate for Payer: Blue Distinction Transplant |
$138.60
|
| Rate for Payer: Blue Shield of California Commercial |
$142.76
|
| Rate for Payer: Blue Shield of California EPN |
$112.27
|
| Rate for Payer: Caremore Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$147.84
|
| Rate for Payer: Cigna of CA PPO |
$170.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Media |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$173.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Central Health Plan Commercial |
$649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$730.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,068.18 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,756.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,546.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,886.42
|
| Rate for Payer: Blue Distinction Transplant |
$1,915.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,394.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,736.99
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Media |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,394.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,117.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.13
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,277.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,596.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,596.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,596.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,705.06
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.60
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,205.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,177.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,152.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.69
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,014.96 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,971.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,616.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,192.09
|
| Rate for Payer: Blue Distinction Transplant |
$3,241.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,052.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,939.23
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Media |
$4,592.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,052.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,891.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,215.23
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,161.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,701.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,701.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,701.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,885.20
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.60
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1,992.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,949.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,782.99
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,360.10
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.40
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.75
|
| Rate for Payer: United Healthcare All Other HMO |
$939.33
|
| Rate for Payer: United Healthcare HMO Rider |
$918.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$840.51
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$891.45 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,400.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,233.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,504.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,528.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,910.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,385.57
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Media |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,910.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$891.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,311.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.27
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,273.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,273.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,273.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,273.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,438.06
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.60
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,016.88
|
| Rate for Payer: United Healthcare All Other HMO |
$993.18
|
| Rate for Payer: United Healthcare HMO Rider |
$971.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$888.69
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$942.55 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,481.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,303.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,591.02
|
| Rate for Payer: Blue Distinction Transplant |
$1,615.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,019.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,464.99
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Media |
$2,289.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,019.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$942.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.13
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,077.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,346.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,346.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,346.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,346.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$287.35 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$451.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$485.05
|
| Rate for Payer: Blue Distinction Transplant |
$492.60
|
| Rate for Payer: Blue Shield of California Commercial |
$615.75
|
| Rate for Payer: Blue Shield of California EPN |
$446.62
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Media |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$615.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.61
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Riverside University Health System MISP |
$328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.50
|
| Rate for Payer: United Healthcare All Other HMO |
$410.50
|
| Rate for Payer: United Healthcare HMO Rider |
$410.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
