|
HC REDUCING SUBSTANCE
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$19.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.18
|
| Rate for Payer: BCBS Transplant Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.56
|
| Rate for Payer: IEHP medi-cal |
$3.58
|
| Rate for Payer: IEHP Medicare Advantage |
$2.17
|
| Rate for Payer: Innovage PACE Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$2.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: Riverside University Health MISP |
$2.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,197.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.00
|
| Rate for Payer: Cigna of CA PPO |
$1,476.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,795.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,496.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,197.00
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$997.50
|
| Rate for Payer: United Healthcare All Other HMO |
$997.50
|
| Rate for Payer: United Healthcare HMO Rider |
$997.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.00
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,795.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.00
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,795.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,197.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,254.86
|
| Rate for Payer: Blue Shield of California EPN |
$975.56
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.00
|
| Rate for Payer: Cigna of CA HMO |
$1,276.80
|
| Rate for Payer: Cigna of CA PPO |
$1,476.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,795.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,496.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,197.00
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,197.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,197.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$997.50
|
| Rate for Payer: United Healthcare All Other HMO |
$997.50
|
| Rate for Payer: United Healthcare HMO Rider |
$997.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,661.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$458.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$559.58
|
| Rate for Payer: BCBS Transplant Transplant |
$1,107.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.83
|
| Rate for Payer: Blue Shield of California EPN |
$897.16
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,476.80
|
| Rate for Payer: Cigna of CA HMO |
$1,181.44
|
| Rate for Payer: Cigna of CA PPO |
$1,366.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,661.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,384.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: IEHP medi-cal |
$378.77
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Innovage PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,107.60
|
| Rate for Payer: Riverside University Health MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,107.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,107.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
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 |
$125.66 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$382.80
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| 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 |
$634.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$125.66
|
| Rate for Payer: IEHP Medicare Advantage |
$512.00
|
| Rate for Payer: Innovage PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$382.80
|
| Rate for Payer: Riverside University Health MISP |
$465.45
|
| 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 |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
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: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$425.55
|
| 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 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: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$328.83
|
| 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/MAIN IMPL PUMP/RESV MD
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
911801004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$295.80
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| 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 |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$369.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$51.54
|
| Rate for Payer: IEHP Medicare Advantage |
$447.77
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| 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 |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
IP
|
$961.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
OP
|
$961.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$162.93 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: BCBS Transplant Transplant |
$576.60
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$615.04
|
| Rate for Payer: Cigna of CA PPO |
$711.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$720.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: IEHP medi-cal |
$162.93
|
| Rate for Payer: IEHP Medicare Advantage |
$324.04
|
| Rate for Payer: Innovage PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$576.60
|
| Rate for Payer: Riverside University Health MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$576.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
OP
|
$961.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$162.93 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: BCBS Transplant Transplant |
$576.60
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$615.04
|
| Rate for Payer: Cigna of CA PPO |
$711.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$720.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: IEHP medi-cal |
$162.93
|
| Rate for Payer: IEHP Medicare Advantage |
$324.04
|
| Rate for Payer: Innovage PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$576.60
|
| Rate for Payer: Riverside University Health MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$576.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
IP
|
$961.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$820.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: BCBS Transplant Transplant |
$646.80
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Central Health Plan Commercial |
$862.40
|
| Rate for Payer: Cigna of CA HMO |
$689.92
|
| Rate for Payer: Cigna of CA PPO |
$797.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$916.30
|
| Rate for Payer: Global Benefits Group Commercial |
$646.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$970.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$808.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: IEHP medi-cal |
$171.77
|
| Rate for Payer: IEHP Medicare Advantage |
$324.04
|
| Rate for Payer: Innovage PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$719.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$808.50
|
| Rate for Payer: Networks By Design Commercial |
$700.70
|
| Rate for Payer: Prime Health Services Commercial |
$916.30
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$646.80
|
| Rate for Payer: Riverside University Health MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$646.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$646.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$970.20 |
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Central Health Plan Commercial |
$862.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$431.20
|
| Rate for Payer: Galaxy Health WC |
$916.30
|
| Rate for Payer: Global Benefits Group Commercial |
$646.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$719.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.60
|
| Rate for Payer: Multiplan Commercial |
$808.50
|
| Rate for Payer: Networks By Design Commercial |
$700.70
|
| Rate for Payer: Prime Health Services Commercial |
$916.30
|
|
|
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 |
$334.60 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$832.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$525.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$462.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.80
|
| Rate for Payer: BCBS Transplant Transplant |
$573.60
|
| Rate for Payer: Blue Shield of California Commercial |
$717.00
|
| Rate for Payer: Blue Shield of California EPN |
$520.06
|
| 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: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$717.00
|
| Rate for Payer: IEHP medi-cal |
$334.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| 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 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 |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| 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 |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Blue Shield of California EPN |
$510.50
|
| 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: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$637.65
|
| 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 |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
OP
|
$14,405.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,833.00 |
| Max. Negotiated Rate |
$12,964.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,643.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,060.74
|
| Rate for Payer: Blue Shield of California EPN |
$7,044.04
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,524.00
|
| Rate for Payer: Cigna of CA HMO |
$9,219.20
|
| Rate for Payer: Cigna of CA PPO |
$10,659.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$12,244.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,643.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,964.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,803.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$4,804.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,881.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$10,803.75
|
| Rate for Payer: Networks By Design Commercial |
$9,363.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,244.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,643.00
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,643.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,643.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,202.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
IP
|
$14,405.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,881.00 |
| Max. Negotiated Rate |
$12,964.50 |
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,524.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,762.00
|
| Rate for Payer: Galaxy Health WC |
$12,244.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,643.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,964.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,608.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,881.00
|
| Rate for Payer: Multiplan Commercial |
$10,803.75
|
| Rate for Payer: Networks By Design Commercial |
$9,363.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,244.25
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
IP
|
$14,405.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,881.00 |
| Max. Negotiated Rate |
$12,964.50 |
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,524.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,762.00
|
| Rate for Payer: Galaxy Health WC |
$12,244.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,643.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,964.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,608.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,881.00
|
| Rate for Payer: Multiplan Commercial |
$10,803.75
|
| Rate for Payer: Networks By Design Commercial |
$9,363.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,244.25
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
OP
|
$14,405.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,964.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,643.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Cash Price |
$6,482.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,524.00
|
| Rate for Payer: Cigna of CA PPO |
$10,659.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$12,244.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,643.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,964.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,803.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,881.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$10,803.75
|
| Rate for Payer: Networks By Design Commercial |
$9,363.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,244.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,643.00
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,643.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,202.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.85
|
| Rate for Payer: BCBS Transplant Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$106.30
|
| Rate for Payer: Blue Shield of California EPN |
$82.64
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
