|
HC SIMULATION INTER
|
Facility
|
OP
|
$2,486.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$2,237.40 |
| Rate for Payer: Adventist Health Commercial |
$497.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$465.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,509.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,011.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,509.00
|
| Rate for Payer: Blue Shield of California EPN |
$986.94
|
| Rate for Payer: Cash Price |
$1,367.30
|
| Rate for Payer: Cash Price |
$1,367.30
|
| Rate for Payer: Cash Price |
$1,367.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.80
|
| Rate for Payer: Cigna of CA HMO |
$1,591.04
|
| Rate for Payer: Cigna of CA PPO |
$1,839.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$2,113.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,237.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: InnovAge PACE Commercial |
$697.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,658.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$1,864.50
|
| Rate for Payer: Networks By Design Commercial |
$1,615.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$465.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,113.10
|
| Rate for Payer: Prime Health Services Medicare |
$493.04
|
| Rate for Payer: Riverside University Health System MISP |
$511.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,491.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC SIMULATION INTER
|
Facility
|
IP
|
$2,486.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
909100105
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$2,237.40 |
| Rate for Payer: Adventist Health Commercial |
$497.20
|
| Rate for Payer: Cash Price |
$1,367.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$994.40
|
| Rate for Payer: Galaxy Health WC |
$2,113.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,237.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,658.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,538.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.20
|
| Rate for Payer: Multiplan Commercial |
$1,864.50
|
| Rate for Payer: Networks By Design Commercial |
$1,615.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,113.10
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$2,507.40 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Cash Price |
$1,532.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,228.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.40
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,507.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,724.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$2,089.50
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
|
|
HC SIMULATION SIMPLE
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
904810302
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$2,507.40 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$168.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,691.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$629.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,691.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,106.04
|
| Rate for Payer: Cash Price |
$1,532.30
|
| Rate for Payer: Cash Price |
$1,532.30
|
| Rate for Payer: Cash Price |
$1,532.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,228.80
|
| Rate for Payer: Cigna of CA HMO |
$1,783.04
|
| Rate for Payer: Cigna of CA PPO |
$2,061.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,507.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: InnovAge PACE Commercial |
$253.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$2,089.50
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$168.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
| Rate for Payer: Prime Health Services Medicare |
$178.82
|
| Rate for Payer: Riverside University Health System MISP |
$185.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,671.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.34
|
| Rate for Payer: Blue Shield of California Commercial |
$525.05
|
| Rate for Payer: Blue Shield of California EPN |
$343.40
|
| Rate for Payer: Cash Price |
$475.75
|
| Rate for Payer: Cash Price |
$475.75
|
| Rate for Payer: Central Health Plan Commercial |
$692.00
|
| Rate for Payer: Cigna of CA HMO |
$553.60
|
| Rate for Payer: Cigna of CA PPO |
$640.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Senior |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$735.25
|
| Rate for Payer: Global Benefits Group Commercial |
$519.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$778.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: InnovAge PACE Commercial |
$485.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$648.75
|
| Rate for Payer: Networks By Design Commercial |
$562.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: Prime Health Services Commercial |
$735.25
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.00 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Cash Price |
$475.75
|
| Rate for Payer: Central Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.00
|
| Rate for Payer: EPIC Health Plan Senior |
$346.00
|
| Rate for Payer: Galaxy Health WC |
$735.25
|
| Rate for Payer: Global Benefits Group Commercial |
$519.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$778.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$535.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Multiplan Commercial |
$648.75
|
| Rate for Payer: Networks By Design Commercial |
$562.25
|
| Rate for Payer: Prime Health Services Commercial |
$735.25
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$477.10
|
| Rate for Payer: Blue Shield of California EPN |
$312.04
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Senior |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: InnovAge PACE Commercial |
$488.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$314.40
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$486.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$800.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.35
|
| Rate for Payer: Blue Shield of California Commercial |
$800.03
|
| Rate for Payer: Blue Shield of California EPN |
$523.25
|
| Rate for Payer: Cash Price |
$724.90
|
| Rate for Payer: Cash Price |
$724.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$843.52
|
| Rate for Payer: Cigna of CA PPO |
$975.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$856.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Cash Price |
$724.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$815.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$856.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,377.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.80
|
| Rate for Payer: EPIC Health Plan Senior |
$688.80
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,549.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,148.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,065.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.40
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,045.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,045.25
|
| Rate for Payer: Blue Shield of California EPN |
$683.63
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,377.60
|
| Rate for Payer: Cigna of CA HMO |
$1,102.08
|
| Rate for Payer: Cigna of CA PPO |
$1,274.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,549.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,148.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,033.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,033.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.78
|
| Rate for Payer: InnovAge PACE Commercial |
$260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.78
|
| Rate for Payer: InnovAge PACE Commercial |
$260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$178.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.67
|
| Rate for Payer: Blue Shield of California Commercial |
$178.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.35
|
| Rate for Payer: InnovAge PACE Commercial |
$115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Riverside University Health System MISP |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$178.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.67
|
| Rate for Payer: Blue Shield of California Commercial |
$178.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.35
|
| Rate for Payer: InnovAge PACE Commercial |
$115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Riverside University Health System MISP |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.01 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.71
|
| Rate for Payer: Blue Shield of California Commercial |
$528.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: InnovAge PACE Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Riverside University Health System MISP |
$273.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.01 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.71
|
| Rate for Payer: Blue Shield of California Commercial |
$528.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: InnovAge PACE Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Riverside University Health System MISP |
$273.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$528.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$528.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.77
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
