|
HC HIGH FLOW 02
|
Facility
OP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.64
|
| Rate for Payer: BCBS Transplant Transplant |
$245.40
|
| Rate for Payer: Blue Shield of California Commercial |
$252.76
|
| Rate for Payer: Blue Shield of California EPN |
$198.77
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$306.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$245.40
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| 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 |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC HIGH FLOW 02
|
Facility
IP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$368.10 |
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.60
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
IP
|
$9,598.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,919.60 |
| Max. Negotiated Rate |
$8,638.20 |
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,678.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,839.20
|
| Rate for Payer: Galaxy Health WC |
$8,158.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,638.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,401.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,919.60
|
| Rate for Payer: Multiplan Commercial |
$7,198.50
|
| Rate for Payer: Networks By Design Commercial |
$6,238.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,158.30
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
OP
|
$9,598.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$8,638.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$782.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,758.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$782.97
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,678.40
|
| Rate for Payer: Cigna of CA HMO |
$6,142.72
|
| Rate for Payer: Cigna of CA PPO |
$7,102.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$8,158.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,638.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,198.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,284.07
|
| Rate for Payer: IEHP medi-cal |
$1,291.90
|
| Rate for Payer: IEHP Medicare Advantage |
$782.97
|
| Rate for Payer: Innovage PACE Commercial |
$1,174.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,401.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,919.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,049.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$7,198.50
|
| Rate for Payer: Networks By Design Commercial |
$6,238.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,158.30
|
| Rate for Payer: Prime Health Services Medicare |
$829.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,758.80
|
| Rate for Payer: Riverside University Health MISP |
$861.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,758.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,758.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
IP
|
$7,641.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,528.20 |
| Max. Negotiated Rate |
$6,876.90 |
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,056.40
|
| Rate for Payer: Galaxy Health WC |
$6,494.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,584.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,876.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,096.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,528.20
|
| Rate for Payer: Multiplan Commercial |
$5,730.75
|
| Rate for Payer: Networks By Design Commercial |
$4,966.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,494.85
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
OP
|
$7,641.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$6,876.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$782.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,584.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$782.97
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Cash Price |
$3,438.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,112.80
|
| Rate for Payer: Cigna of CA HMO |
$4,890.24
|
| Rate for Payer: Cigna of CA PPO |
$5,654.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$6,494.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,584.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,876.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,730.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,284.07
|
| Rate for Payer: IEHP medi-cal |
$1,291.90
|
| Rate for Payer: IEHP Medicare Advantage |
$782.97
|
| Rate for Payer: Innovage PACE Commercial |
$1,174.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,528.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,049.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$5,730.75
|
| Rate for Payer: Networks By Design Commercial |
$4,966.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,494.85
|
| Rate for Payer: Prime Health Services Medicare |
$829.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,584.60
|
| Rate for Payer: Riverside University Health MISP |
$861.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,584.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,584.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
IP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Blue Shield of California EPN |
$364.72
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.60
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
OP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$1,192.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,192.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$375.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$375.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$330.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.52
|
| Rate for Payer: BCBS Transplant Transplant |
$409.80
|
| Rate for Payer: Blue Shield of California Commercial |
$512.25
|
| Rate for Payer: Blue Shield of California EPN |
$371.55
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$580.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$512.25
|
| Rate for Payer: IEHP medi-cal |
$239.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.03
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Riverside University Health MISP |
$273.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.50
|
| Rate for Payer: United Healthcare All Other HMO |
$341.50
|
| Rate for Payer: United Healthcare HMO Rider |
$341.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$341.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$580.55
|
| Rate for Payer: Vantage Medical Group Senior |
$580.55
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
OP
|
$666.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$566.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$366.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$366.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$399.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$566.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$499.50
|
| Rate for Payer: IEHP medi-cal |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: Riverside University Health MISP |
$266.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.10
|
| Rate for Payer: Vantage Medical Group Senior |
$566.10
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
IP
|
$666.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
OP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
905352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$386.05 |
| Max. Negotiated Rate |
$1,374.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,374.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$606.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$606.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.65
|
| Rate for Payer: BCBS Transplant Transplant |
$661.80
|
| Rate for Payer: Blue Shield of California Commercial |
$827.25
|
| Rate for Payer: Blue Shield of California EPN |
$600.03
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$937.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$827.25
|
| Rate for Payer: IEHP medi-cal |
$386.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.23
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Riverside University Health MISP |
$441.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$551.50
|
| Rate for Payer: United Healthcare All Other HMO |
$551.50
|
| Rate for Payer: United Healthcare HMO Rider |
$551.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$937.55
|
| Rate for Payer: Vantage Medical Group Senior |
$937.55
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
IP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
905352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Blue Shield of California EPN |
$589.00
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
|
|
HC HIP JT ADJ FLEXION EA
|
Facility
IP
|
$778.00
|
|
|
Service Code
|
CPT L2622
|
| Hospital Charge Code |
905352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Blue Shield of California EPN |
$415.45
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Central Health Plan Commercial |
$622.40
|
| Rate for Payer: Cigna of CA HMO |
$544.60
|
| Rate for Payer: Cigna of CA PPO |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$700.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.60
|
| Rate for Payer: Multiplan Commercial |
$583.50
|
| Rate for Payer: Networks By Design Commercial |
$389.00
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
|
HC HIP JT ADJ FLEXION EA
|
Facility
OP
|
$778.00
|
|
|
Service Code
|
CPT L2622
|
| Hospital Charge Code |
905352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$1,273.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,273.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$427.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$427.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$376.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.64
|
| Rate for Payer: BCBS Transplant Transplant |
$466.80
|
| Rate for Payer: Blue Shield of California Commercial |
$583.50
|
| Rate for Payer: Blue Shield of California EPN |
$423.23
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Central Health Plan Commercial |
$622.40
|
| Rate for Payer: Cigna of CA HMO |
$544.60
|
| Rate for Payer: Cigna of CA PPO |
$544.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$700.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$583.50
|
| Rate for Payer: IEHP medi-cal |
$272.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.98
|
| Rate for Payer: Multiplan Commercial |
$583.50
|
| Rate for Payer: Networks By Design Commercial |
$389.00
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Riverside University Health MISP |
$311.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.00
|
| Rate for Payer: United Healthcare All Other HMO |
$389.00
|
| Rate for Payer: United Healthcare HMO Rider |
$389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.30
|
| Rate for Payer: Vantage Medical Group Senior |
$661.30
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
OP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$861.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$852.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$526.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$526.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$463.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.40
|
| Rate for Payer: BCBS Transplant Transplant |
$574.20
|
| Rate for Payer: Blue Shield of California Commercial |
$717.75
|
| Rate for Payer: Blue Shield of California EPN |
$520.61
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Central Health Plan Commercial |
$765.60
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$861.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$717.75
|
| Rate for Payer: IEHP medi-cal |
$334.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.37
|
| Rate for Payer: Multiplan Commercial |
$717.75
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: Riverside University Health MISP |
$382.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.50
|
| Rate for Payer: United Healthcare All Other HMO |
$478.50
|
| Rate for Payer: United Healthcare HMO Rider |
$478.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.45
|
| Rate for Payer: Vantage Medical Group Senior |
$813.45
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
IP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$861.30 |
| Rate for Payer: Blue Shield of California EPN |
$511.04
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Central Health Plan Commercial |
$765.60
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$861.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.40
|
| Rate for Payer: Multiplan Commercial |
$717.75
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$1,452.60 |
| Rate for Payer: Blue Shield of California EPN |
$861.88
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,291.20
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,452.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$564.90 |
| Max. Negotiated Rate |
$1,977.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,977.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$887.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$781.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$953.55
|
| Rate for Payer: BCBS Transplant Transplant |
$968.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,210.50
|
| Rate for Payer: Blue Shield of California EPN |
$878.02
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,291.20
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,452.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,210.50
|
| Rate for Payer: IEHP medi-cal |
$564.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.74
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Riverside University Health MISP |
$645.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$807.00
|
| Rate for Payer: United Healthcare All Other HMO |
$807.00
|
| Rate for Payer: United Healthcare HMO Rider |
$807.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$807.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
IP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$1,070.10 |
| Rate for Payer: Blue Shield of California EPN |
$634.93
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Central Health Plan Commercial |
$951.20
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,070.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.80
|
| Rate for Payer: Multiplan Commercial |
$891.75
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
OP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$416.15 |
| Max. Negotiated Rate |
$1,110.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,110.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$653.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$653.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$575.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$702.46
|
| Rate for Payer: BCBS Transplant Transplant |
$713.40
|
| Rate for Payer: Blue Shield of California Commercial |
$891.75
|
| Rate for Payer: Blue Shield of California EPN |
$646.82
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Central Health Plan Commercial |
$951.20
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,010.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,070.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$891.75
|
| Rate for Payer: IEHP medi-cal |
$416.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.49
|
| Rate for Payer: Multiplan Commercial |
$891.75
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: Riverside University Health MISP |
$475.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$713.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$713.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.50
|
| Rate for Payer: United Healthcare All Other HMO |
$594.50
|
| Rate for Payer: United Healthcare HMO Rider |
$594.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$594.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,010.65
|
|
|
HC HIP JT LOCK EA
|
Facility
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Blue Shield of California EPN |
$542.01
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
|
|
HC HIP JT LOCK EA
|
Facility
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,008.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,008.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$558.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$491.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$599.66
|
| Rate for Payer: BCBS Transplant Transplant |
$609.00
|
| Rate for Payer: Blue Shield of California Commercial |
$761.25
|
| Rate for Payer: Blue Shield of California EPN |
$552.16
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$761.25
|
| Rate for Payer: IEHP medi-cal |
$355.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.15
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Riverside University Health MISP |
$406.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.50
|
| Rate for Payer: United Healthcare All Other HMO |
$507.50
|
| Rate for Payer: United Healthcare HMO Rider |
$507.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$54,212.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.62
|
| Rate for Payer: BCBS Transplant Transplant |
$213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$220.01
|
| Rate for Payer: Blue Shield of California EPN |
$173.02
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Central Health Plan Commercial |
$284.80
|
| Rate for Payer: Cigna of CA HMO |
$227.84
|
| Rate for Payer: Cigna of CA PPO |
$263.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$267.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: IEHP medi-cal |
$1,772.71
|
| Rate for Payer: IEHP Medicare Advantage |
$1,074.37
|
| Rate for Payer: Innovage PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$213.60
|
| Rate for Payer: Riverside University Health MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54,212.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC HISTONE AUTO AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
