|
HC MR SAFETY IMPL ELECTRONICS PREP SUP PHYS/QHP
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
908801504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$655.57 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$482.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$655.57
|
| Rate for Payer: Blue Shield of California Commercial |
$202.23
|
| Rate for Payer: Blue Shield of California EPN |
$127.44
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Central Health Plan Commercial |
$256.80
|
| Rate for Payer: Cigna of CA HMO |
$205.44
|
| Rate for Payer: Cigna of CA PPO |
$237.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.76
|
| Rate for Payer: EPIC Health Plan Senior |
$134.51
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.86
|
| Rate for Payer: Multiplan Commercial |
$240.75
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.28
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
| Rate for Payer: Prime Health Services Medicare |
$129.62
|
| Rate for Payer: Riverside University Health System MISP |
$134.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.50
|
| Rate for Payer: United Healthcare All Other HMO |
$160.50
|
| Rate for Payer: United Healthcare HMO Rider |
$160.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.51
|
| Rate for Payer: Vantage Medical Group Senior |
$122.28
|
|
|
HC MR SAFETY IMPL ELECTRONICS PREP SUP PHYS/QHP
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
908801504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Central Health Plan Commercial |
$256.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$128.40
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.20
|
| Rate for Payer: Multiplan Commercial |
$240.75
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
|
|
HC MR SAFETY IMPL POS/IMMOBL SUP PHYS/QHP
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
908801505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC MR SAFETY IMPL POS/IMMOBL SUP PHYS/QHP
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
908801505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$1,003.65 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$738.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$721.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.65
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$82.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.00
|
| Rate for Payer: United Healthcare All Other HMO |
$104.00
|
| Rate for Payer: United Healthcare HMO Rider |
$104.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC MR SAFETY MED PHYSICS EXAM CUSTOM PLN/MTR
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
908801503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$591.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$536.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$498.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC MR SAFETY MED PHYSICS EXAM CUSTOM PLN/MTR
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
908801503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,555.72 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,146.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,119.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,555.72
|
| Rate for Payer: Blue Shield of California Commercial |
$532.35
|
| Rate for Payer: Blue Shield of California EPN |
$335.46
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$591.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$536.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Other HMO |
$422.50
|
| Rate for Payer: United Healthcare HMO Rider |
$422.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MSCL TST MNL W RPT; EXT OR TRK
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800411
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.69
|
| Rate for Payer: Blue Shield of California Commercial |
$279.09
|
| Rate for Payer: Blue Shield of California EPN |
$175.87
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC MSCL TST MNL W RPT; EXT OR TRK
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800411
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.60
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC MSI
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,672.02 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$348.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$348.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$836.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$836.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,202.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,202.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,672.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,672.02
|
| Rate for Payer: Blue Shield of California Commercial |
$568.26
|
| Rate for Payer: Blue Shield of California Commercial |
$782.46
|
| Rate for Payer: Blue Shield of California EPN |
$358.09
|
| Rate for Payer: Blue Shield of California EPN |
$493.07
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: Cigna of CA HMO |
$577.28
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$667.48
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.12
|
| Rate for Payer: EPIC Health Plan Senior |
$383.42
|
| Rate for Payer: EPIC Health Plan Senior |
$383.42
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$571.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$571.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.07
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$348.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$348.56
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Prime Health Services Medicare |
$369.47
|
| Rate for Payer: Prime Health Services Medicare |
$369.47
|
| Rate for Payer: Riverside University Health System MISP |
$383.42
|
| Rate for Payer: Riverside University Health System MISP |
$383.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.33
|
| Rate for Payer: United Healthcare All Other HMO |
$282.33
|
| Rate for Payer: United Healthcare All Other HMO |
$282.33
|
| Rate for Payer: United Healthcare HMO Rider |
$282.33
|
| Rate for Payer: United Healthcare HMO Rider |
$282.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$348.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$348.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
|
|
HC MSI
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
|
HC MSLT OR MWT REDUCED SVC
|
Facility
|
IP
|
$3,127.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
903600033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$625.40 |
| Max. Negotiated Rate |
$2,814.30 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.80
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,985.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,844.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
|
|
HC MSLT OR MWT REDUCED SVC
|
Facility
|
OP
|
$3,127.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
903600033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$336.64 |
| Max. Negotiated Rate |
$7,061.00 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,104.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,266.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,145.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,818.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,970.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,241.42
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,985.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,170.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,214.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,876.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,327.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC MTR URN 400ML DRAIN BAG
|
Facility
|
OP
|
$75.69
|
|
| Hospital Charge Code |
901698821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$68.12 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.03
|
| Rate for Payer: Blue Shield of California Commercial |
$47.99
|
| Rate for Payer: Blue Shield of California EPN |
$30.20
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$60.55
|
| Rate for Payer: Cigna of CA HMO |
$48.44
|
| Rate for Payer: Cigna of CA PPO |
$56.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.28
|
| Rate for Payer: EPIC Health Plan Senior |
$30.28
|
| Rate for Payer: Galaxy Health WC |
$64.34
|
| Rate for Payer: Global Benefits Group Commercial |
$45.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.98
|
| Rate for Payer: Multiplan Commercial |
$56.77
|
| Rate for Payer: Networks By Design Commercial |
$49.20
|
| Rate for Payer: Prime Health Services Commercial |
$64.34
|
| Rate for Payer: Riverside University Health System MISP |
$30.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.84
|
| Rate for Payer: United Healthcare All Other HMO |
$37.84
|
| Rate for Payer: United Healthcare HMO Rider |
$37.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.34
|
| Rate for Payer: Vantage Medical Group Senior |
$64.34
|
|
|
HC MTR URN 400ML DRAIN BAG
|
Facility
|
IP
|
$75.69
|
|
| Hospital Charge Code |
901698821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$68.12 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$60.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.28
|
| Rate for Payer: EPIC Health Plan Senior |
$30.28
|
| Rate for Payer: Galaxy Health WC |
$64.34
|
| Rate for Payer: Global Benefits Group Commercial |
$45.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$56.77
|
| Rate for Payer: Networks By Design Commercial |
$49.20
|
| Rate for Payer: Prime Health Services Commercial |
$64.34
|
|
|
HC MTR URN 400ML DRAIN BAG L/F LL
|
Facility
|
IP
|
$56.50
|
|
| Hospital Charge Code |
901607518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Adventist Health Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Central Health Plan Commercial |
$45.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.60
|
| Rate for Payer: EPIC Health Plan Senior |
$22.60
|
| Rate for Payer: Galaxy Health WC |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$33.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Multiplan Commercial |
$42.38
|
| Rate for Payer: Networks By Design Commercial |
$36.73
|
| Rate for Payer: Prime Health Services Commercial |
$48.02
|
|
|
HC MTR URN 400ML DRAIN BAG L/F LL
|
Facility
|
OP
|
$56.50
|
|
| Hospital Charge Code |
901607518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Adventist Health Commercial |
$11.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.87
|
| Rate for Payer: Blue Shield of California Commercial |
$35.82
|
| Rate for Payer: Blue Shield of California EPN |
$22.54
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Central Health Plan Commercial |
$45.20
|
| Rate for Payer: Cigna of CA HMO |
$36.16
|
| Rate for Payer: Cigna of CA PPO |
$41.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.60
|
| Rate for Payer: EPIC Health Plan Senior |
$22.60
|
| Rate for Payer: Galaxy Health WC |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$33.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.55
|
| Rate for Payer: Multiplan Commercial |
$42.38
|
| Rate for Payer: Networks By Design Commercial |
$36.73
|
| Rate for Payer: Prime Health Services Commercial |
$48.02
|
| Rate for Payer: Riverside University Health System MISP |
$22.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.25
|
| Rate for Payer: United Healthcare All Other HMO |
$28.25
|
| Rate for Payer: United Healthcare HMO Rider |
$28.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.02
|
| Rate for Payer: Vantage Medical Group Senior |
$48.02
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,873.95 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,328.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,589.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,793.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,288.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,589.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,873.95 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,328.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,589.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,793.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,288.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,589.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.75
|
| Rate for Payer: Blue Shield of California Commercial |
$98.90
|
| Rate for Payer: Blue Shield of California EPN |
$62.24
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.69
|
| Rate for Payer: Blue Shield of California Commercial |
$86.86
|
| Rate for Payer: Blue Shield of California EPN |
$54.66
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.80
|
| Rate for Payer: Blue Shield of California Commercial |
$173.08
|
| Rate for Payer: Blue Shield of California EPN |
$108.93
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Riverside University Health System MISP |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
