|
HC SURGICAL BOOT CHILD EA
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.44
|
| Rate for Payer: Blue Shield of California Commercial |
$38.53
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Adventist Health Commercial |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.45
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.90
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.08
|
| Rate for Payer: Blue Shield of California Commercial |
$69.98
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Cash Price |
$242.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$377.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.51
|
| Rate for Payer: Multiplan Commercial |
$431.70
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.26
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$404.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.28
|
| Rate for Payer: Cash Price |
$242.83
|
| Rate for Payer: Cigna of CA HMO |
$345.36
|
| Rate for Payer: Cigna of CA PPO |
$399.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$458.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$458.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$377.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$377.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$377.74
|
| Rate for Payer: Multiplan Commercial |
$431.70
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.81
|
| Rate for Payer: United Healthcare All Other HMO |
$269.81
|
| Rate for Payer: United Healthcare HMO Rider |
$269.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.69
|
| Rate for Payer: Vantage Medical Group Senior |
$458.69
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$1,529.15 |
| Rate for Payer: Adventist Health Commercial |
$359.80
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$719.60
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,142.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,061.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.76
|
| Rate for Payer: Multiplan Commercial |
$1,439.20
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$359.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,154.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cigna of CA HMO |
$1,151.36
|
| Rate for Payer: Cigna of CA PPO |
$1,331.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,142.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,439.20
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,079.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,435.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,165.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,633.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,633.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,190.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,240.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,873.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,447.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$5,924.25
|
| Rate for Payer: Cash Price |
$5,924.25
|
| Rate for Payer: Cigna of CA HMO |
$8,425.60
|
| Rate for Payer: Cigna of CA PPO |
$9,742.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,190.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,190.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,190.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,266.00
|
| Rate for Payer: Galaxy Health WC |
$11,190.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,899.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,359.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,778.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,767.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,215.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,215.50
|
| Rate for Payer: Multiplan Commercial |
$10,532.00
|
| Rate for Payer: Networks By Design Commercial |
$8,557.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,190.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,899.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,582.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,582.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,582.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,582.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,190.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,190.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,190.25
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
IP
|
$13,165.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,633.00 |
| Max. Negotiated Rate |
$11,190.25 |
| Rate for Payer: Adventist Health Commercial |
$2,633.00
|
| Rate for Payer: Cash Price |
$5,924.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,266.00
|
| Rate for Payer: Galaxy Health WC |
$11,190.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,899.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,359.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,767.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,159.60
|
| Rate for Payer: Multiplan Commercial |
$10,532.00
|
| Rate for Payer: Networks By Design Commercial |
$8,557.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,190.25
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$1,189.15 |
| Rate for Payer: Adventist Health Commercial |
$279.80
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$979.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.60
|
| Rate for Payer: EPIC Health Plan Senior |
$559.60
|
| Rate for Payer: Galaxy Health WC |
$1,189.15
|
| Rate for Payer: Global Benefits Group Commercial |
$839.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$888.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$825.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.76
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: Networks By Design Commercial |
$909.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,189.15
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$1,189.15 |
| Rate for Payer: Adventist Health Commercial |
$279.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.57
|
| Rate for Payer: Blue Shield of California Commercial |
$588.98
|
| Rate for Payer: Blue Shield of California Commercial |
$892.56
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: Cigna of CA HMO |
$895.36
|
| Rate for Payer: Cigna of CA PPO |
$1,035.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$979.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,189.15
|
| Rate for Payer: Global Benefits Group Commercial |
$839.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$888.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: Networks By Design Commercial |
$909.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,189.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$839.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$839.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.69 |
| Max. Negotiated Rate |
$6,081.75 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,399.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$5,724.00
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,081.75 |
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,221.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.20
|
| Rate for Payer: Multiplan Commercial |
$5,724.00
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.22
|
| Rate for Payer: Blue Shield of California Commercial |
$48.87
|
| Rate for Payer: Blue Shield of California Commercial |
$73.88
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
915352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.05
|
| Rate for Payer: Blue Shield of California Commercial |
$115.35
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.05
|
| Rate for Payer: Blue Shield of California Commercial |
$115.35
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
915352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC SUTR AND STPL REMOVAL NOT REQ ANES
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
907205854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$617.95 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$508.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$461.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$428.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.48
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
|
