|
HC SPLNT ORTHO-GLASS 2"PER FT
|
Facility
|
OP
|
$22.14
|
|
| Hospital Charge Code |
901603585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.60
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$16.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.07
|
| Rate for Payer: United Healthcare All Other HMO |
$11.07
|
| Rate for Payer: United Healthcare HMO Rider |
$11.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.82
|
| Rate for Payer: Vantage Medical Group Senior |
$18.82
|
|
|
HC SPLNT ORTHO-GLASS 2"PER FT
|
Facility
|
IP
|
$22.14
|
|
| Hospital Charge Code |
901603585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
|
|
HC SPLNT ORTHO-GLASS 3" PER FT
|
Facility
|
OP
|
$34.03
|
|
| Hospital Charge Code |
901602642
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.93 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.90
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cigna of CA HMO |
$21.78
|
| Rate for Payer: Cigna of CA PPO |
$25.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.61
|
| Rate for Payer: EPIC Health Plan Senior |
$13.61
|
| Rate for Payer: Galaxy Health WC |
$28.93
|
| Rate for Payer: Global Benefits Group Commercial |
$20.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$27.22
|
| Rate for Payer: Networks By Design Commercial |
$22.12
|
| Rate for Payer: Prime Health Services Commercial |
$28.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO |
$17.02
|
| Rate for Payer: United Healthcare HMO Rider |
$17.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.93
|
| Rate for Payer: Vantage Medical Group Senior |
$28.93
|
|
|
HC SPLNT ORTHO-GLASS 3" PER FT
|
Facility
|
IP
|
$34.03
|
|
| Hospital Charge Code |
901602642
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.93 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.61
|
| Rate for Payer: EPIC Health Plan Senior |
$13.61
|
| Rate for Payer: Galaxy Health WC |
$28.93
|
| Rate for Payer: Global Benefits Group Commercial |
$20.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.22
|
| Rate for Payer: Networks By Design Commercial |
$22.12
|
| Rate for Payer: Prime Health Services Commercial |
$28.93
|
|
|
HC SPLNT ORTHO-GLASS 4" PER FT
|
Facility
|
OP
|
$40.84
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$34.71 |
| Rate for Payer: Adventist Health Commercial |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.08
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cigna of CA HMO |
$26.14
|
| Rate for Payer: Cigna of CA PPO |
$30.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Senior |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$34.71
|
| Rate for Payer: Global Benefits Group Commercial |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$32.67
|
| Rate for Payer: Networks By Design Commercial |
$26.55
|
| Rate for Payer: Prime Health Services Commercial |
$34.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.42
|
| Rate for Payer: United Healthcare All Other HMO |
$20.42
|
| Rate for Payer: United Healthcare HMO Rider |
$20.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.71
|
| Rate for Payer: Vantage Medical Group Senior |
$34.71
|
|
|
HC SPLNT ORTHO-GLASS 4" PER FT
|
Facility
|
IP
|
$40.84
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$34.71 |
| Rate for Payer: Adventist Health Commercial |
$8.17
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Senior |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$34.71
|
| Rate for Payer: Global Benefits Group Commercial |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$32.67
|
| Rate for Payer: Networks By Design Commercial |
$26.55
|
| Rate for Payer: Prime Health Services Commercial |
$34.71
|
|
|
HC SPLNT ORTHO-GLASS 5" PER FT
|
Facility
|
IP
|
$46.08
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Adventist Health Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: EPIC Health Plan Senior |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$36.86
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
|
|
HC SPLNT ORTHO-GLASS 5" PER FT
|
Facility
|
OP
|
$46.08
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
901602298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Adventist Health Commercial |
$9.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.30
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna of CA HMO |
$29.49
|
| Rate for Payer: Cigna of CA PPO |
$34.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: EPIC Health Plan Senior |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.26
|
| Rate for Payer: Multiplan Commercial |
$36.86
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO |
$23.04
|
| Rate for Payer: United Healthcare HMO Rider |
$23.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.17
|
| Rate for Payer: Vantage Medical Group Senior |
$39.17
|
|
|
HC SPLNT PLASTER 5X45 50/BX
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
|
|
HC SPLNT PLASTER 5X45 50/BX
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.55
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cigna of CA HMO |
$15.17
|
| Rate for Payer: Cigna of CA PPO |
$17.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.59
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO |
$11.85
|
| Rate for Payer: United Healthcare HMO Rider |
$11.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.14
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
|
OP
|
$2,349.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$399.67 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$469.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,291.95
|
| Rate for Payer: Cash Price |
$1,291.95
|
| Rate for Payer: Cash Price |
$1,291.95
|
| Rate for Payer: Cigna of CA HMO |
$1,503.36
|
| Rate for Payer: Cigna of CA PPO |
$1,738.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,996.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,409.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$399.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,879.20
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,526.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,996.65
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,409.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
|
IP
|
$2,349.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$469.80 |
| Max. Negotiated Rate |
$1,996.65 |
| Rate for Payer: Adventist Health Commercial |
$469.80
|
| Rate for Payer: Cash Price |
$1,291.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.60
|
| Rate for Payer: EPIC Health Plan Senior |
$939.60
|
| Rate for Payer: Galaxy Health WC |
$1,996.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,409.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$894.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,454.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.76
|
| Rate for Payer: Multiplan Commercial |
$1,879.20
|
| Rate for Payer: Networks By Design Commercial |
$1,526.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,996.65
|
|
|
HC SPUTUM COLLECTION
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$232.70
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
|
|
HC SPUTUM COLLECTION
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Cigna of CA HMO |
$229.12
|
| Rate for Payer: Cigna of CA PPO |
$264.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$232.70
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SSA AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
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 |
$94.05
|
| 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 Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| 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 SSA AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| 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 Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$114.40
|
| Rate for Payer: Blue Shield of California EPN |
$75.58
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| 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 HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| 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 Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SSB AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
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 |
$94.05
|
| 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 Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| 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 SSB AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| 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 Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$114.40
|
| Rate for Payer: Blue Shield of California EPN |
$75.58
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| 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 HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| 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 Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC STAINLESS/GRAPHITE PER BAR
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
905352770
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Senior |
$144.00
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Networks By Design Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
|
|
HC STAINLESS/GRAPHITE PER BAR
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
905352770
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna of CA HMO |
$230.40
|
| Rate for Payer: Cigna of CA PPO |
$266.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Senior |
$144.00
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Networks By Design Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO |
$180.00
|
| Rate for Payer: United Healthcare HMO Rider |
$180.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.00
|
| Rate for Payer: Vantage Medical Group Senior |
$306.00
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
OP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
915355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,023.36 |
| Max. Negotiated Rate |
$24,874.40 |
| Rate for Payer: Adventist Health Commercial |
$11,998.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,095.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,948.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,949.71
|
| Rate for Payer: Blue Shield of California Commercial |
$21,596.83
|
| Rate for Payer: Blue Shield of California EPN |
$14,222.30
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,874.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,665.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,519.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,240.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,114.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,023.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,484.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,484.80
|
| Rate for Payer: Multiplan Commercial |
$23,411.20
|
| Rate for Payer: Networks By Design Commercial |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24,874.40
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
OP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
905355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,023.36 |
| Max. Negotiated Rate |
$24,874.40 |
| Rate for Payer: Adventist Health Commercial |
$11,998.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,095.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,948.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,949.71
|
| Rate for Payer: Blue Shield of California Commercial |
$21,596.83
|
| Rate for Payer: Blue Shield of California EPN |
$14,222.30
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,874.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,665.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,519.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,240.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,114.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,023.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,484.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,484.80
|
| Rate for Payer: Multiplan Commercial |
$23,411.20
|
| Rate for Payer: Networks By Design Commercial |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24,874.40
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
IP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
915355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,852.80 |
| Max. Negotiated Rate |
$24,874.40 |
| Rate for Payer: Adventist Health Commercial |
$5,852.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,519.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,149.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,114.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,023.36
|
| Rate for Payer: Multiplan Commercial |
$23,411.20
|
| Rate for Payer: Networks By Design Commercial |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
IP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
905355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,852.80 |
| Max. Negotiated Rate |
$24,874.40 |
| Rate for Payer: Adventist Health Commercial |
$5,852.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cash Price |
$16,095.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,519.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,149.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,114.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,023.36
|
| Rate for Payer: Multiplan Commercial |
$23,411.20
|
| Rate for Payer: Networks By Design Commercial |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
|
|
HC STAPHAUREX MRSA NON-BILLABLE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
