|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$2,638.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$386.94 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,081.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,106.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Cigna of CA HMO |
$1,688.32
|
| Rate for Payer: Cigna of CA PPO |
$1,952.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,582.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$2,638.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$2,374.20 |
| Rate for Payer: Adventist Health Commercial |
$527.60
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,055.20
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,556.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$2,638.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$2,374.20 |
| Rate for Payer: Adventist Health Commercial |
$527.60
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,055.20
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,556.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$2,638.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.94 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$527.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Cigna of CA HMO |
$1,688.32
|
| Rate for Payer: Cigna of CA PPO |
$1,952.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Adventist Health Commercial |
$361.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$550.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$458.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.15
|
| Rate for Payer: Blue Shield of California EPN |
$716.59
|
| Rate for Payer: Cash Price |
$812.25
|
| Rate for Payer: Cash Price |
$812.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,444.00
|
| Rate for Payer: Cigna of CA HMO |
$1,155.20
|
| Rate for Payer: Cigna of CA PPO |
$1,335.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,263.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,534.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,083.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,624.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,146.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,353.75
|
| Rate for Payer: Networks By Design Commercial |
$1,173.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,534.25
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,083.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,083.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.00 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Adventist Health Commercial |
$361.00
|
| Rate for Payer: Cash Price |
$812.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,444.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,263.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$722.00
|
| Rate for Payer: EPIC Health Plan Senior |
$722.00
|
| Rate for Payer: Galaxy Health WC |
$1,534.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,083.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,624.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,146.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,064.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.75
|
| Rate for Payer: Networks By Design Commercial |
$1,173.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,534.25
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$405.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$376.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| 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: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$405.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV MD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
911801004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| 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: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$485.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$313.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV MD
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
911801004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$313.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$777.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Cigna of CA HMO |
$544.64
|
| Rate for Payer: Cigna of CA PPO |
$629.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$540.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$777.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Cigna of CA HMO |
$544.64
|
| Rate for Payer: Cigna of CA PPO |
$629.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$540.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$540.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$540.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$859.50 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Central Health Plan Commercial |
$764.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$668.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.00
|
| Rate for Payer: EPIC Health Plan Senior |
$382.00
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$859.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$606.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$563.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$934.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Central Health Plan Commercial |
$764.00
|
| Rate for Payer: Cigna of CA HMO |
$611.20
|
| Rate for Payer: Cigna of CA PPO |
$706.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$668.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$859.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$606.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Blue Shield of California Commercial |
$766.71
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$556.11
|
| Rate for Payer: Blue Shield of California Commercial |
$766.71
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Riverside University Health System MISP |
$382.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$556.11
|
| Rate for Payer: Blue Shield of California Commercial |
$766.71
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Riverside University Health System MISP |
$382.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Blue Shield of California Commercial |
$766.71
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$3,566.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: Cigna of CA HMO |
$11,413.76
|
| Rate for Payer: Cigna of CA PPO |
$13,197.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,483.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,324.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,700.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,917.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,917.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,917.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,917.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$7,311.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,072.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: Cigna of CA HMO |
$11,413.76
|
| Rate for Payer: Cigna of CA PPO |
$13,197.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,483.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,324.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,700.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,700.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,566.80 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$3,566.80
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,483.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,133.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,133.60
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,324.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,522.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,566.80 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$3,566.80
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,483.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,133.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,133.60
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,324.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,522.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.34
|
| Rate for Payer: Blue Shield of California Commercial |
$126.80
|
| Rate for Payer: Blue Shield of California EPN |
$79.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
