|
HC TISS CUL NEO SOLID TUMOR
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.00
|
| Rate for Payer: Blue Shield of California Commercial |
$197.35
|
| Rate for Payer: Blue Shield of California EPN |
$130.39
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cigna of CA HMO |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$218.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$236.00
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NEO SOLID TUMOR
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$342.55 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$249.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.55
|
| Rate for Payer: Blue Shield of California Commercial |
$121.09
|
| Rate for Payer: Blue Shield of California EPN |
$80.00
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.55
|
| Rate for Payer: Blue Shield of California Commercial |
$194.68
|
| Rate for Payer: Blue Shield of California EPN |
$128.62
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$976.91 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$976.91
|
| Rate for Payer: Blue Shield of California Commercial |
$457.60
|
| Rate for Payer: Blue Shield of California EPN |
$302.33
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: EPIC Health Plan Senior |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Adventist Health Commercial |
$189.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$379.20
|
| Rate for Payer: Galaxy Health WC |
$805.80
|
| Rate for Payer: Global Benefits Group Commercial |
$568.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$632.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.52
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: Networks By Design Commercial |
$616.20
|
| Rate for Payer: Prime Health Services Commercial |
$805.80
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$1,179.99 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,179.99
|
| Rate for Payer: Blue Shield of California Commercial |
$194.68
|
| Rate for Payer: Blue Shield of California EPN |
$128.62
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$342.55 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$249.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$1,864.90 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,270.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,619.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.28
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO |
$1,535.80
|
| Rate for Payer: Cigna of CA PPO |
$1,535.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Senior |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,535.80
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Networks By Design Commercial |
$1,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.41
|
| Rate for Payer: United Healthcare All Other HMO |
$801.47
|
| Rate for Payer: United Healthcare HMO Rider |
$784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO |
$1,535.80
|
| Rate for Payer: Cigna of CA PPO |
$1,535.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Senior |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.56
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Networks By Design Commercial |
$1,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.41
|
| Rate for Payer: United Healthcare All Other HMO |
$801.47
|
| Rate for Payer: United Healthcare HMO Rider |
$784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.53
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$58.12 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.12
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.48
|
| Rate for Payer: Blue Shield of California Commercial |
$316.60
|
| Rate for Payer: Blue Shield of California EPN |
$208.49
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO |
$300.30
|
| Rate for Payer: Cigna of CA PPO |
$300.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$300.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$343.20
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.71
|
| Rate for Payer: United Healthcare HMO Rider |
$153.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO |
$300.30
|
| Rate for Payer: Cigna of CA PPO |
$300.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$343.20
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.71
|
| Rate for Payer: United Healthcare HMO Rider |
$153.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.73
|
| Rate for Payer: Blue Shield of California Commercial |
$300.37
|
| Rate for Payer: Blue Shield of California EPN |
$197.80
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cigna of CA HMO |
$284.90
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.90
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.75
|
| Rate for Payer: United Healthcare All Other HMO |
$148.68
|
| Rate for Payer: United Healthcare HMO Rider |
$145.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Vantage Medical Group Senior |
$345.95
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cigna of CA HMO |
$284.90
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.68
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.75
|
| Rate for Payer: United Healthcare All Other HMO |
$148.68
|
| Rate for Payer: United Healthcare HMO Rider |
$145.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.29
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Blue Shield of California Commercial |
$405.90
|
| Rate for Payer: Blue Shield of California EPN |
$267.30
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$340.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.41
|
| Rate for Payer: United Healthcare All Other HMO |
$200.91
|
| Rate for Payer: United Healthcare HMO Rider |
$196.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.12
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$302.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$412.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.75
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna of CA HMO |
$385.00
|
| Rate for Payer: Cigna of CA PPO |
$385.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$467.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$467.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$340.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Networks By Design Commercial |
$275.00
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.41
|
| Rate for Payer: United Healthcare All Other HMO |
$200.91
|
| Rate for Payer: United Healthcare HMO Rider |
$196.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$467.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Vantage Medical Group Senior |
$467.50
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.38
|
| Rate for Payer: Blue Shield of California Commercial |
$498.17
|
| Rate for Payer: Blue Shield of California EPN |
$328.86
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$520.96
|
| Rate for Payer: Cigna of CA PPO |
$602.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
915350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$1,160.00
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
905350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$1,232.50 |
| Rate for Payer: Adventist Health Commercial |
$594.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,087.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,070.10
|
| Rate for Payer: Blue Shield of California EPN |
$704.70
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,232.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,232.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$811.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$1,160.00
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
|
HC TLSO 2 PIECE RIGID SHELL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT L0491
|
| Hospital Charge Code |
915350491
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$1,232.50 |
| Rate for Payer: Adventist Health Commercial |
$594.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,087.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,070.10
|
| Rate for Payer: Blue Shield of California EPN |
$704.70
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna of CA HMO |
$1,015.00
|
| Rate for Payer: Cigna of CA PPO |
$1,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,232.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,232.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$580.00
|
| Rate for Payer: Galaxy Health WC |
$1,232.50
|
| Rate for Payer: Global Benefits Group Commercial |
$870.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$811.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$897.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$1,160.00
|
| Rate for Payer: Networks By Design Commercial |
$725.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,232.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$544.18
|
| Rate for Payer: United Healthcare All Other HMO |
$529.68
|
| Rate for Payer: United Healthcare HMO Rider |
$518.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,232.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,232.50
|
|
