|
HC MR SAFETY IMPL ELECTRONICS PREP SUP PHYS/QHP
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
908801504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$471.55 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$116.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.70
|
| Rate for Payer: Blue Shield of California Commercial |
$194.85
|
| Rate for Payer: Blue Shield of California EPN |
$127.44
|
| Rate for Payer: Cash Price |
$176.55
|
| Rate for Payer: Cash Price |
$176.55
|
| Rate for Payer: Central Health Plan Commercial |
$256.80
|
| Rate for Payer: Cigna of CA HMO |
$205.44
|
| Rate for Payer: Cigna of CA PPO |
$237.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.45
|
| Rate for Payer: EPIC Health Plan Senior |
$116.63
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.63
|
| Rate for Payer: InnovAge PACE Commercial |
$174.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.28
|
| Rate for Payer: Multiplan Commercial |
$240.75
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
| Rate for Payer: Prime Health Services Medicare |
$123.63
|
| Rate for Payer: Riverside University Health System MISP |
$128.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.50
|
| Rate for Payer: United Healthcare All Other HMO |
$160.50
|
| Rate for Payer: United Healthcare HMO Rider |
$160.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.29
|
| Rate for Payer: Vantage Medical Group Senior |
$116.63
|
|
|
HC MR SAFETY IMPL POS/IMMOBL SUP PHYS/QHP
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
908801505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$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 MR SAFETY IMPL POS/IMMOBL SUP PHYS/QHP
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
908801505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$721.92 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$721.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.52
|
| 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 |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.00
|
| Rate for Payer: United Healthcare All Other HMO |
$104.00
|
| Rate for Payer: United Healthcare HMO Rider |
$104.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC MR SAFETY MED PHYSICS EXAM CUSTOM PLN/MTR
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
908801503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC MR SAFETY MED PHYSICS EXAM CUSTOM PLN/MTR
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
908801503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,119.03 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,119.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.11
|
| Rate for Payer: Blue Shield of California Commercial |
$512.91
|
| Rate for Payer: Blue Shield of California EPN |
$335.46
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Other HMO |
$422.50
|
| Rate for Payer: United Healthcare HMO Rider |
$422.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MSCL TST MNL W RPT; EXT OR TRK
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800411
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.17
|
| Rate for Payer: Blue Shield of California Commercial |
$268.90
|
| Rate for Payer: Blue Shield of California EPN |
$175.87
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MSCL TST MNL W RPT; EXT OR TRK
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800411
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.60
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC MSI
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$811.80 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Cash Price |
$496.10
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.80
|
| Rate for Payer: EPIC Health Plan Senior |
$360.80
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$558.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
|
|
HC MSI
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$1,202.68 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$348.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$547.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,202.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.09
|
| Rate for Payer: Blue Shield of California Commercial |
$547.51
|
| Rate for Payer: Blue Shield of California EPN |
$358.09
|
| Rate for Payer: Cash Price |
$496.10
|
| Rate for Payer: Cash Price |
$496.10
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: Cigna of CA HMO |
$577.28
|
| Rate for Payer: Cigna of CA PPO |
$667.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.56
|
| Rate for Payer: EPIC Health Plan Senior |
$348.56
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$571.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: InnovAge PACE Commercial |
$522.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.07
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$348.56
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
| Rate for Payer: Prime Health Services Medicare |
$369.47
|
| Rate for Payer: Riverside University Health System MISP |
$383.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$541.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.33
|
| Rate for Payer: United Healthcare All Other HMO |
$282.33
|
| Rate for Payer: United Healthcare HMO Rider |
$282.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$348.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
|
|
HC MSLT OR MWT REDUCED SVC
|
Facility
|
OP
|
$3,127.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
903600033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$336.64 |
| Max. Negotiated Rate |
$2,814.30 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,899.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,145.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,836.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,898.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,241.42
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,876.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC MSLT OR MWT REDUCED SVC
|
Facility
|
IP
|
$3,127.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
903600033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$625.40 |
| Max. Negotiated Rate |
$2,814.30 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.80
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,935.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
|
|
HC MSS DV8 ESOPHAGEAL RETRACTOR
|
Facility
|
OP
|
$3,101.00
|
|
| Hospital Charge Code |
906812704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$2,790.90 |
| Rate for Payer: Adventist Health Commercial |
$620.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,883.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,705.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,325.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,501.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,821.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,894.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,237.30
|
| Rate for Payer: Cash Price |
$1,705.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,984.64
|
| Rate for Payer: Cigna of CA PPO |
$2,294.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,790.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,919.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,170.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,170.70
|
| Rate for Payer: Multiplan Commercial |
$2,325.75
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,240.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,550.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,550.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,550.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,550.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.85
|
|
|
HC MSS DV8 ESOPHAGEAL RETRACTOR
|
Facility
|
IP
|
$3,101.00
|
|
| Hospital Charge Code |
906812704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$2,790.90 |
| Rate for Payer: Adventist Health Commercial |
$620.20
|
| Rate for Payer: Cash Price |
$1,705.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,480.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,790.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,919.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.20
|
| Rate for Payer: Multiplan Commercial |
$2,325.75
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
|
|
HC MTR URN 400ML DRAIN BAG
|
Facility
|
IP
|
$75.69
|
|
| Hospital Charge Code |
901698821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$68.12 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Central Health Plan Commercial |
$60.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.28
|
| Rate for Payer: EPIC Health Plan Senior |
$30.28
|
| Rate for Payer: Galaxy Health WC |
$64.34
|
| Rate for Payer: Global Benefits Group Commercial |
$45.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$56.77
|
| Rate for Payer: Networks By Design Commercial |
$49.20
|
| Rate for Payer: Prime Health Services Commercial |
$64.34
|
|
|
HC MTR URN 400ML DRAIN BAG
|
Facility
|
OP
|
$75.69
|
|
| Hospital Charge Code |
901698821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$68.12 |
| Rate for Payer: Adventist Health Commercial |
$15.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.45
|
| Rate for Payer: Blue Shield of California Commercial |
$46.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.20
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Central Health Plan Commercial |
$60.55
|
| Rate for Payer: Cigna of CA HMO |
$48.44
|
| Rate for Payer: Cigna of CA PPO |
$56.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.28
|
| Rate for Payer: EPIC Health Plan Senior |
$30.28
|
| Rate for Payer: Galaxy Health WC |
$64.34
|
| Rate for Payer: Global Benefits Group Commercial |
$45.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.12
|
| Rate for Payer: InnovAge PACE Commercial |
$37.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.98
|
| Rate for Payer: Multiplan Commercial |
$56.77
|
| Rate for Payer: Networks By Design Commercial |
$49.20
|
| Rate for Payer: Prime Health Services Commercial |
$64.34
|
| Rate for Payer: Riverside University Health System MISP |
$30.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.84
|
| Rate for Payer: United Healthcare All Other HMO |
$37.84
|
| Rate for Payer: United Healthcare HMO Rider |
$37.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.34
|
| Rate for Payer: Vantage Medical Group Senior |
$64.34
|
|
|
HC MTR URN 400ML DRAIN BAG L/F LL
|
Facility
|
IP
|
$56.50
|
|
| Hospital Charge Code |
901607518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Adventist Health Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Central Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.60
|
| Rate for Payer: EPIC Health Plan Senior |
$22.60
|
| Rate for Payer: Galaxy Health WC |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$33.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Multiplan Commercial |
$42.38
|
| Rate for Payer: Networks By Design Commercial |
$36.73
|
| Rate for Payer: Prime Health Services Commercial |
$48.02
|
|
|
HC MTR URN 400ML DRAIN BAG L/F LL
|
Facility
|
OP
|
$56.50
|
|
| Hospital Charge Code |
901607518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Adventist Health Commercial |
$11.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.18
|
| Rate for Payer: Blue Shield of California Commercial |
$34.52
|
| Rate for Payer: Blue Shield of California EPN |
$22.54
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Central Health Plan Commercial |
$45.20
|
| Rate for Payer: Cigna of CA HMO |
$36.16
|
| Rate for Payer: Cigna of CA PPO |
$41.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.60
|
| Rate for Payer: EPIC Health Plan Senior |
$22.60
|
| Rate for Payer: Galaxy Health WC |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$33.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.85
|
| Rate for Payer: InnovAge PACE Commercial |
$28.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.55
|
| Rate for Payer: Multiplan Commercial |
$42.38
|
| Rate for Payer: Networks By Design Commercial |
$36.73
|
| Rate for Payer: Prime Health Services Commercial |
$48.02
|
| Rate for Payer: Riverside University Health System MISP |
$22.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.25
|
| Rate for Payer: United Healthcare All Other HMO |
$28.25
|
| Rate for Payer: United Healthcare HMO Rider |
$28.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.02
|
| Rate for Payer: Vantage Medical Group Senior |
$48.02
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,423.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,873.95 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,360.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,423.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,793.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,861.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,005.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,288.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,423.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,873.95 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,360.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,423.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,793.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,861.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,005.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,288.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.46
|
| Rate for Payer: Blue Shield of California Commercial |
$83.71
|
| Rate for Payer: Blue Shield of California EPN |
$54.66
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: InnovAge PACE Commercial |
$68.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.62
|
| Rate for Payer: Blue Shield of California Commercial |
$95.32
|
| Rate for Payer: Blue Shield of California EPN |
$62.24
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: InnovAge PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.00
|
| Rate for Payer: United Healthcare All Other HMO |
$78.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
