|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$1,116.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.32 |
| Max. Negotiated Rate |
$1,572.54 |
| Rate for Payer: Adventist Health Commercial |
$703.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,008.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,423.56
|
| Rate for Payer: InnovAge PACE Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,572.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Riverside University Health System MISP |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
915351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$4,191.30 |
| Rate for Payer: Adventist Health Commercial |
$931.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,599.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,347.13
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,725.60
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,191.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.40
|
| Rate for Payer: Multiplan Commercial |
$3,492.75
|
| Rate for Payer: Networks By Design Commercial |
$3,027.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,463.34 |
| Max. Negotiated Rate |
$4,191.30 |
| Rate for Payer: Adventist Health Commercial |
$1,909.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,735.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,599.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,347.13
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,725.60
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,191.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,463.34
|
| Rate for Payer: InnovAge PACE Commercial |
$2,328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,909.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.90
|
| Rate for Payer: Multiplan Commercial |
$3,492.75
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,862.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$4,191.30 |
| Rate for Payer: Adventist Health Commercial |
$931.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,599.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,347.13
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,725.60
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,191.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.40
|
| Rate for Payer: Multiplan Commercial |
$3,492.75
|
| Rate for Payer: Networks By Design Commercial |
$3,027.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
915351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,463.34 |
| Max. Negotiated Rate |
$4,191.30 |
| Rate for Payer: Adventist Health Commercial |
$1,909.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,735.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,599.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,347.13
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,725.60
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,191.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,463.34
|
| Rate for Payer: InnovAge PACE Commercial |
$2,328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,909.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.90
|
| Rate for Payer: Multiplan Commercial |
$3,492.75
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,862.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
915352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.55
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
915352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.55
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$8,700.30 |
| Rate for Payer: Adventist Health Commercial |
$1,933.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,472.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,872.17
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,733.60
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,700.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,933.40
|
| Rate for Payer: Multiplan Commercial |
$7,250.25
|
| Rate for Payer: Networks By Design Commercial |
$6,283.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
915355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,165.94 |
| Max. Negotiated Rate |
$8,700.30 |
| Rate for Payer: Adventist Health Commercial |
$3,963.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,677.43
|
| Rate for Payer: Blue Shield of California Commercial |
$7,472.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,872.17
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,733.60
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,700.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,406.06
|
| Rate for Payer: InnovAge PACE Commercial |
$4,833.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,963.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,766.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,766.90
|
| Rate for Payer: Multiplan Commercial |
$7,250.25
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,866.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
915355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$8,700.30 |
| Rate for Payer: Adventist Health Commercial |
$1,933.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,472.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,872.17
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,733.60
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,700.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,933.40
|
| Rate for Payer: Multiplan Commercial |
$7,250.25
|
| Rate for Payer: Networks By Design Commercial |
$6,283.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,165.94 |
| Max. Negotiated Rate |
$8,700.30 |
| Rate for Payer: Adventist Health Commercial |
$3,963.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,677.43
|
| Rate for Payer: Blue Shield of California Commercial |
$7,472.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,872.17
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,733.60
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,700.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,406.06
|
| Rate for Payer: InnovAge PACE Commercial |
$4,833.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,963.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,766.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,766.90
|
| Rate for Payer: Multiplan Commercial |
$7,250.25
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,866.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$232.48
|
| Rate for Payer: Blue Shield of California EPN |
$152.05
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| 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 |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
|
|
HC LEUK ALK PHOS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC LEUK ALK PHOS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$62.54 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.69
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.60
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.60
|
| Rate for Payer: InnovAge PACE Commercial |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$9.12
|
| Rate for Payer: Riverside University Health System MISP |
$9.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.60
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| 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 Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| 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 LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.30
|
| Rate for Payer: Blue Shield of California Commercial |
$126.26
|
| Rate for Payer: Blue Shield of California EPN |
$82.58
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| 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 |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.80
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$35.57
|
| Rate for Payer: InnovAge PACE Commercial |
$104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.60
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$83.20
|
| 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 |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.20
|
| Rate for Payer: EPIC Health Plan Senior |
$445.20
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$688.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$675.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$637.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$653.66
|
| Rate for Payer: Blue Shield of California Commercial |
$675.59
|
| Rate for Payer: Blue Shield of California EPN |
$441.86
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: Cigna of CA HMO |
$712.32
|
| Rate for Payer: Cigna of CA PPO |
$823.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: Blue Shield of California Commercial |
$37.03
|
| Rate for Payer: Blue Shield of California EPN |
$24.22
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
