|
HC PMIC110
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.43
|
| Rate for Payer: Blue Shield of California Commercial |
$55.44
|
| Rate for Payer: Blue Shield of California EPN |
$34.94
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.65
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$9.17
|
| Rate for Payer: Riverside University Health System MISP |
$9.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC PMIC110
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC PNCTR ASP OF HYDRCLE, TV, W WO INJ OF MED
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
909081550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$2,251.80 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,588.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,476.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
|
|
HC PNCTR ASP OF HYDRCLE, TV, W WO INJ OF MED
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
909081550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.06 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| Rate for Payer: Cigna of CA HMO |
$1,601.28
|
| Rate for Payer: Cigna of CA PPO |
$1,851.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,751.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,251.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,588.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
915354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.69
|
| Rate for Payer: Blue Shield of California Commercial |
$153.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Riverside University Health System MISP |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
915354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$153.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
905354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$153.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
905354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.69
|
| Rate for Payer: Blue Shield of California Commercial |
$153.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Riverside University Health System MISP |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
905354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$202.16 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.32
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
915354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
905354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
915354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$202.16 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.32
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC PNEUMATIC KNEE SPLINT
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT L4380
|
| Hospital Charge Code |
905354380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$179.10 |
| Rate for Payer: Adventist Health Commercial |
$81.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.76
|
| Rate for Payer: Blue Shield of California Commercial |
$159.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.30
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.20
|
| Rate for Payer: Cigna of CA HMO |
$139.30
|
| Rate for Payer: Cigna of CA PPO |
$139.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$169.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$139.30
|
| Rate for Payer: Multiplan Commercial |
$149.25
|
| Rate for Payer: Networks By Design Commercial |
$99.50
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Riverside University Health System MISP |
$79.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.68
|
| Rate for Payer: United Healthcare All Other HMO |
$72.69
|
| Rate for Payer: United Healthcare HMO Rider |
$71.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.15
|
| Rate for Payer: Vantage Medical Group Senior |
$169.15
|
|
|
HC PNEUMATIC KNEE SPLINT
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT L4380
|
| Hospital Charge Code |
905354380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$179.10 |
| Rate for Payer: Adventist Health Commercial |
$39.80
|
| Rate for Payer: Blue Shield of California Commercial |
$159.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.30
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.20
|
| Rate for Payer: Cigna of CA HMO |
$139.30
|
| Rate for Payer: Cigna of CA PPO |
$139.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.80
|
| Rate for Payer: Multiplan Commercial |
$149.25
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.68
|
| Rate for Payer: United Healthcare All Other HMO |
$72.69
|
| Rate for Payer: United Healthcare HMO Rider |
$71.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Blue Shield of California Commercial |
$433.88
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Central Health Plan Commercial |
$432.80
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.20
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: Networks By Design Commercial |
$351.65
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Blue Shield of California Commercial |
$433.88
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Central Health Plan Commercial |
$432.80
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.20
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: Networks By Design Commercial |
$351.65
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.70
|
| Rate for Payer: Blue Shield of California Commercial |
$433.88
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Central Health Plan Commercial |
$432.80
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Riverside University Health System MISP |
$216.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.70
|
| Rate for Payer: Blue Shield of California Commercial |
$433.88
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Central Health Plan Commercial |
$432.80
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$343.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Riverside University Health System MISP |
$216.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.17
|
| Rate for Payer: Blue Shield of California Commercial |
$115.92
|
| Rate for Payer: Blue Shield of California Commercial |
$28.98
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Blue Shield of California EPN |
$73.05
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.56
|
| Rate for Payer: Blue Shield of California Commercial |
$597.49
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$597.49
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC POL D 5 (PAPER WASP), IGE
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.50
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Central Health Plan Commercial |
$13.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$10.48
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.92
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$12.29
|
| Rate for Payer: Networks By Design Commercial |
$10.65
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.92
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC POL D 5 (PAPER WASP), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.17
|
| Rate for Payer: Blue Shield of California Commercial |
$28.98
|
| Rate for Payer: Blue Shield of California Commercial |
$107.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
