|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$111.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$230.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$230.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$230.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$230.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.35
|
| Rate for Payer: InnovAge PACE Commercial |
$135.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.70
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Riverside University Health System MISP |
$108.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$230.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$230.35
|
| Rate for Payer: Vantage Medical Group Senior |
$230.35
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$111.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$230.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$230.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$230.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$230.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.35
|
| Rate for Payer: InnovAge PACE Commercial |
$135.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.70
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Riverside University Health System MISP |
$108.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$230.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$230.35
|
| Rate for Payer: Vantage Medical Group Senior |
$230.35
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Central Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Central Health Plan Commercial |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$132.48
|
| Rate for Payer: Cigna of CA PPO |
$153.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.79
|
| Rate for Payer: InnovAge PACE Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
| Rate for Payer: Riverside University Health System MISP |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC MOHC LNAR DISK
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC MOHC LNAR DISK
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.97
|
| Rate for Payer: Blue Shield of California Commercial |
$20.77
|
| Rate for Payer: Blue Shield of California EPN |
$13.57
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: InnovAge PACE Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.03
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.02
|
| Rate for Payer: InnovAge PACE Commercial |
$487.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Riverside University Health System MISP |
$389.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.03
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.02
|
| Rate for Payer: InnovAge PACE Commercial |
$487.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Riverside University Health System MISP |
$389.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.41 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.68
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$355.23
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.41 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.68
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$355.23
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED SHLDR ARM FOREARM &WRST
|
Facility
|
IP
|
$1,860.00
|
|
| Hospital Charge Code |
903203963
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Adventist Health Commercial |
$372.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,437.78
|
| Rate for Payer: Blue Shield of California EPN |
$937.44
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,488.00
|
| Rate for Payer: Cigna of CA HMO |
$1,302.00
|
| Rate for Payer: Cigna of CA PPO |
$1,302.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.00
|
| Rate for Payer: EPIC Health Plan Senior |
$744.00
|
| Rate for Payer: Galaxy Health WC |
$1,581.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,116.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,674.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,240.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,151.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,581.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.06
|
| Rate for Payer: United Healthcare All Other HMO |
$679.46
|
| Rate for Payer: United Healthcare HMO Rider |
$664.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$609.15
|
|
|
HC MOLDED SHLDR ARM FOREARM &WRST
|
Facility
|
OP
|
$1,860.00
|
|
| Hospital Charge Code |
903203963
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.15 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,581.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,023.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,395.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,092.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,437.78
|
| Rate for Payer: Blue Shield of California EPN |
$937.44
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,488.00
|
| Rate for Payer: Cigna of CA HMO |
$1,302.00
|
| Rate for Payer: Cigna of CA PPO |
$1,302.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,581.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,581.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.00
|
| Rate for Payer: EPIC Health Plan Senior |
$744.00
|
| Rate for Payer: Galaxy Health WC |
$1,581.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,116.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,674.00
|
| Rate for Payer: InnovAge PACE Commercial |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,240.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,151.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,302.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,302.00
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: Networks By Design Commercial |
$930.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,581.00
|
| Rate for Payer: Riverside University Health System MISP |
$744.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,116.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,116.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.06
|
| Rate for Payer: United Healthcare All Other HMO |
$679.46
|
| Rate for Payer: United Healthcare HMO Rider |
$664.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$609.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,581.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,581.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,581.00
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
IP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$346.96 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: Central Health Plan Commercial |
$308.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.20
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.10
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
OP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,234.22 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.49
|
| Rate for Payer: Blue Shield of California Commercial |
$234.00
|
| Rate for Payer: Blue Shield of California EPN |
$153.05
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: Cash Price |
$173.48
|
| Rate for Payer: Central Health Plan Commercial |
$308.41
|
| Rate for Payer: Cigna of CA HMO |
$246.73
|
| Rate for Payer: Cigna of CA PPO |
$285.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$343.80 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Central Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.40
|
| Rate for Payer: Multiplan Commercial |
$286.50
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$343.80 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.75
|
| Rate for Payer: Blue Shield of California Commercial |
$231.87
|
| Rate for Payer: Blue Shield of California EPN |
$151.65
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Central Health Plan Commercial |
$305.60
|
| Rate for Payer: Cigna of CA HMO |
$244.48
|
| Rate for Payer: Cigna of CA PPO |
$282.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$324.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.38
|
| Rate for Payer: InnovAge PACE Commercial |
$191.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.40
|
| Rate for Payer: Multiplan Commercial |
$286.50
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
| Rate for Payer: Riverside University Health System MISP |
$152.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.70
|
| Rate for Payer: Vantage Medical Group Senior |
$324.70
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$658.00
|
| Rate for Payer: United Healthcare All Other HMO |
$658.00
|
| Rate for Payer: United Healthcare HMO Rider |
$658.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$658.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$539.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$772.89
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
