|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Shield of California Commercial |
$20.28
|
| Rate for Payer: Blue Shield of California Commercial |
$119.19
|
| Rate for Payer: Blue Shield of California Commercial |
$30.67
|
| Rate for Payer: Blue Shield of California Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
915355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.87
|
| Rate for Payer: Blue Shield of California Commercial |
$502.93
|
| Rate for Payer: Blue Shield of California Commercial |
$331.58
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
915355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.87
|
| Rate for Payer: Blue Shield of California Commercial |
$502.93
|
| Rate for Payer: Blue Shield of California Commercial |
$331.58
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: EPIC Health Plan Senior |
$14.31
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.50
|
| Rate for Payer: Blue Shield of California Commercial |
$27.25
|
| Rate for Payer: Blue Shield of California Commercial |
$41.19
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna of CA HMO |
$37.82
|
| Rate for Payer: Cigna of CA PPO |
$43.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$47.28
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$50.23 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.64
|
| Rate for Payer: EPIC Health Plan Senior |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$47.28
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$1,544.67 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$417.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,544.67
|
| Rate for Payer: Blue Shield of California Commercial |
$345.75
|
| Rate for Payer: Blue Shield of California Commercial |
$522.75
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.58
|
| Rate for Payer: EPIC Health Plan Senior |
$203.72
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,432.53 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$729.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,432.53
|
| Rate for Payer: Blue Shield of California Commercial |
$485.78
|
| Rate for Payer: Blue Shield of California Commercial |
$734.46
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.23
|
| Rate for Payer: EPIC Health Plan Senior |
$331.49
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,481.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,481.31
|
| Rate for Payer: Blue Shield of California Commercial |
$485.78
|
| Rate for Payer: Blue Shield of California Commercial |
$734.46
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.75
|
| Rate for Payer: EPIC Health Plan Senior |
$311.17
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$475.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$676.19
|
| Rate for Payer: Blue Shield of California Commercial |
$485.78
|
| Rate for Payer: Blue Shield of California Commercial |
$734.46
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$737.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$737.62
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.88
|
| Rate for Payer: United Healthcare All Other HMO |
$526.88
|
| Rate for Payer: United Healthcare HMO Rider |
$526.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
915353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.32
|
| Rate for Payer: Blue Shield of California Commercial |
$163.03
|
| Rate for Payer: Blue Shield of California Commercial |
$107.48
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
915353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.32
|
| Rate for Payer: Blue Shield of California Commercial |
$163.03
|
| Rate for Payer: Blue Shield of California Commercial |
$107.48
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
915353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
915353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
905353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
905353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC SO AC TYPE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
915353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
