|
HC PLUG DECANNULATION 10.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$23.60
|
| Rate for Payer: Blue Shield of California EPN |
$15.41
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: InnovAge PACE Commercial |
$19.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$23.60
|
| Rate for Payer: Blue Shield of California EPN |
$15.41
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: InnovAge PACE Commercial |
$19.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$23.60
|
| Rate for Payer: Blue Shield of California EPN |
$15.41
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: InnovAge PACE Commercial |
$19.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$23.60
|
| Rate for Payer: Blue Shield of California EPN |
$15.41
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: InnovAge PACE Commercial |
$19.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
OP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18.93
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.79
|
| Rate for Payer: Cigna of CA HMO |
$19.83
|
| Rate for Payer: Cigna of CA PPO |
$22.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.34
|
| Rate for Payer: Global Benefits Group Commercial |
$18.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.89
|
| Rate for Payer: InnovAge PACE Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: Networks By Design Commercial |
$20.14
|
| Rate for Payer: Prime Health Services Commercial |
$26.34
|
| Rate for Payer: Riverside University Health System MISP |
$12.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.49
|
| Rate for Payer: United Healthcare All Other HMO |
$15.49
|
| Rate for Payer: United Healthcare HMO Rider |
$15.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Vantage Medical Group Senior |
$26.34
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
IP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.34
|
| Rate for Payer: Global Benefits Group Commercial |
$18.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: Networks By Design Commercial |
$20.14
|
| Rate for Payer: Prime Health Services Commercial |
$26.34
|
|
|
HC PMIC110
|
Facility
|
IP
|
$92.47
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$83.22 |
| Rate for Payer: Adventist Health Commercial |
$18.49
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Central Health Plan Commercial |
$73.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.99
|
| Rate for Payer: EPIC Health Plan Senior |
$36.99
|
| Rate for Payer: Galaxy Health WC |
$78.60
|
| Rate for Payer: Global Benefits Group Commercial |
$55.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.49
|
| Rate for Payer: Multiplan Commercial |
$69.35
|
| Rate for Payer: Networks By Design Commercial |
$60.11
|
| Rate for Payer: Prime Health Services Commercial |
$78.60
|
|
|
HC PMIC110
|
Facility
|
OP
|
$92.47
|
|
|
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 |
$18.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.16
|
| 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 |
$12.76
|
| Rate for Payer: Blue Shield of California Commercial |
$56.13
|
| Rate for Payer: Blue Shield of California EPN |
$36.71
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Central Health Plan Commercial |
$73.98
|
| Rate for Payer: Cigna of CA HMO |
$59.18
|
| Rate for Payer: Cigna of CA PPO |
$68.43
|
| 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: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$78.60
|
| Rate for Payer: Global Benefits Group Commercial |
$55.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.22
|
| 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: InnovAge PACE Commercial |
$12.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$69.35
|
| Rate for Payer: Networks By Design Commercial |
$60.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.65
|
| Rate for Payer: Prime Health Services Commercial |
$78.60
|
| 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 |
$55.48
|
| 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 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 |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,211.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,469.42
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC 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 |
$1,376.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,001.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,548.74
|
| 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 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 |
$112.76
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| 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: 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: InnovAge PACE Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$148.42
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$105.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| 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 |
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 |
$148.42
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$105.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| 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 |
$112.76
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| 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: 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: InnovAge PACE Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$124.51
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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: 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: InnovAge PACE Commercial |
$106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| 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 |
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 |
$124.51
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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: 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: InnovAge PACE Commercial |
$106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| 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 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 |
$116.87
|
| Rate for Payer: Blue Shield of California Commercial |
$153.83
|
| Rate for Payer: Blue Shield of California EPN |
$100.30
|
| Rate for Payer: Cash Price |
$109.45
|
| 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: 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: InnovAge PACE Commercial |
$99.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.30
|
| Rate for Payer: Molina Healthcare of CA 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 |
$153.83
|
| Rate for Payer: Blue Shield of California EPN |
$100.30
|
| Rate for Payer: Cash Price |
$109.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| 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 |
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 |
$418.19
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$297.55
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| 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 |
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 |
$418.19
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$297.55
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| 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
|
|
