|
HC SWALLOW D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8998
|
| Hospital Charge Code |
900018220
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SWALLOW GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8997
|
| Hospital Charge Code |
900018219
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SWALLOW GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8997
|
| Hospital Charge Code |
900018119
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SWALLOW GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8997
|
| Hospital Charge Code |
900018119
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SWALLOW GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8997
|
| Hospital Charge Code |
900018219
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SWALLOWING STUDY W VIDEO
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
909001803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.80 |
| Max. Negotiated Rate |
$976.65 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$804.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.60
|
| Rate for Payer: EPIC Health Plan Senior |
$459.60
|
| Rate for Payer: Galaxy Health WC |
$976.65
|
| Rate for Payer: Global Benefits Group Commercial |
$689.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$729.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$677.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.76
|
| Rate for Payer: Multiplan Commercial |
$919.20
|
| Rate for Payer: Networks By Design Commercial |
$746.85
|
| Rate for Payer: Prime Health Services Commercial |
$976.65
|
|
|
HC SWALLOWING STUDY W VIDEO
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
909001803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$976.65 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.66
|
| Rate for Payer: Blue Shield of California Commercial |
$483.73
|
| Rate for Payer: Blue Shield of California Commercial |
$733.06
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Cigna of CA HMO |
$735.36
|
| Rate for Payer: Cigna of CA PPO |
$850.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$804.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$976.65
|
| Rate for Payer: Global Benefits Group Commercial |
$689.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$729.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$919.20
|
| Rate for Payer: Networks By Design Commercial |
$746.85
|
| Rate for Payer: Prime Health Services Commercial |
$976.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$689.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$689.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC SWEAT CHLORIDE, IONTOPHORESIS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
900910257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$130.01 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.01
|
| Rate for Payer: Blue Shield of California Commercial |
$144.75
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$218.86
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$200.96
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Cigna of CA PPO |
$232.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC SWEAT CHLORIDE, IONTOPHORESIS
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
900910257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC SWEAT CHLORIDE MEASUREMENT
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900910680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: Adventist Health Commercial |
$41.20
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.40
|
| Rate for Payer: EPIC Health Plan Senior |
$82.40
|
| Rate for Payer: Galaxy Health WC |
$175.10
|
| Rate for Payer: Global Benefits Group Commercial |
$123.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.44
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Networks By Design Commercial |
$133.90
|
| Rate for Payer: Prime Health Services Commercial |
$175.10
|
|
|
HC SWEAT CHLORIDE MEASUREMENT
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900910680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: Adventist Health Commercial |
$41.20
|
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California Commercial |
$143.58
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Blue Shield of California Commercial |
$94.97
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$131.84
|
| Rate for Payer: Cigna of CA PPO |
$152.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.50
|
| Rate for Payer: EPIC Health Plan Senior |
$5.50
|
| Rate for Payer: Galaxy Health WC |
$175.10
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$123.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$133.90
|
| Rate for Payer: Prime Health Services Commercial |
$175.10
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
|
|
HC SWIMSUITS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
|
|
HC SWIMSUITS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.32
|
| Rate for Payer: Blue Shield of California Commercial |
$49.69
|
| Rate for Payer: Blue Shield of California Commercial |
$75.36
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$49.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC SWIMSUITS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.32
|
| Rate for Payer: Blue Shield of California Commercial |
$49.69
|
| Rate for Payer: Blue Shield of California Commercial |
$75.36
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$49.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC SWIMSUITS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
|
|
HC SX TX OF ANAL FISTULA;TS, SS, ES OR MLTPL
|
Facility
|
OP
|
$8,711.00
|
|
|
Service Code
|
CPT 46280
|
| Hospital Charge Code |
906706280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,742.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,742.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$3,919.95
|
| Rate for Payer: Cash Price |
$3,919.95
|
| Rate for Payer: Cash Price |
$3,919.95
|
| Rate for Payer: Cigna of CA HMO |
$5,575.04
|
| Rate for Payer: Cigna of CA PPO |
$6,446.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,097.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$7,404.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,226.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,531.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,090.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$6,968.80
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$5,662.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,404.35
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,226.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,355.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC SX TX OF ANAL FISTULA;TS, SS, ES OR MLTPL
|
Facility
|
IP
|
$8,711.00
|
|
|
Service Code
|
CPT 46280
|
| Hospital Charge Code |
906706280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,742.20 |
| Max. Negotiated Rate |
$7,404.35 |
| Rate for Payer: Adventist Health Commercial |
$1,742.20
|
| Rate for Payer: Cash Price |
$3,919.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,097.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.40
|
| Rate for Payer: Galaxy Health WC |
$7,404.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,226.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,531.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,139.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,090.64
|
| Rate for Payer: Multiplan Commercial |
$6,968.80
|
| Rate for Payer: Networks By Design Commercial |
$5,662.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,404.35
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
905355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$458.25
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
915355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$599.25 |
| Rate for Payer: Adventist Health Commercial |
$289.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$528.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.74
|
| Rate for Payer: Blue Shield of California Commercial |
$542.14
|
| Rate for Payer: Blue Shield of California Commercial |
$357.44
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$599.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$493.50
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.25
|
| Rate for Payer: Vantage Medical Group Senior |
$599.25
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
905355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$599.25 |
| Rate for Payer: Adventist Health Commercial |
$289.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$528.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.74
|
| Rate for Payer: Blue Shield of California Commercial |
$542.14
|
| Rate for Payer: Blue Shield of California Commercial |
$357.44
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$599.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$493.50
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.25
|
| Rate for Payer: Vantage Medical Group Senior |
$599.25
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
915355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$458.25
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
905355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Adventist Health Commercial |
$166.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.75
|
| Rate for Payer: Blue Shield of California Commercial |
$312.21
|
| Rate for Payer: Blue Shield of California Commercial |
$205.84
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
905355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
915355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
915355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Adventist Health Commercial |
$166.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.75
|
| Rate for Payer: Blue Shield of California Commercial |
$312.21
|
| Rate for Payer: Blue Shield of California Commercial |
$205.84
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
