|
HC TRUFILL N-BCA
|
Facility
|
IP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$5,299.75 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Cash Price |
$3,429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,494.00
|
| Rate for Payer: Galaxy Health WC |
$5,299.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,741.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,158.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,859.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,496.40
|
| Rate for Payer: Multiplan Commercial |
$4,988.00
|
| Rate for Payer: Networks By Design Commercial |
$4,052.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,299.75
|
|
|
HC TRUFILL N-BCA
|
Facility
|
OP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$5,299.75 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,089.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,429.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,676.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,828.91
|
| Rate for Payer: Cash Price |
$3,429.25
|
| Rate for Payer: Cigna of CA HMO |
$3,990.40
|
| Rate for Payer: Cigna of CA PPO |
$4,613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,299.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,299.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,494.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,494.00
|
| Rate for Payer: Galaxy Health WC |
$5,299.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,741.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,158.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,859.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,496.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,364.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,364.50
|
| Rate for Payer: Multiplan Commercial |
$4,988.00
|
| Rate for Payer: Networks By Design Commercial |
$4,052.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,299.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,741.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,741.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,117.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,117.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,117.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,117.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,299.75
|
|
|
HC TRUSS ADDITION SCROTAL PAD
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT L8330
|
| Hospital Charge Code |
905358330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cigna of CA HMO |
$100.10
|
| Rate for Payer: Cigna of CA PPO |
$100.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.67
|
| Rate for Payer: United Healthcare All Other HMO |
$52.24
|
| Rate for Payer: United Healthcare HMO Rider |
$51.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.83
|
|
|
HC TRUSS ADDITION SCROTAL PAD
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT L8330
|
| Hospital Charge Code |
905358330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$58.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.83
|
| Rate for Payer: Blue Shield of California Commercial |
$105.53
|
| Rate for Payer: Blue Shield of California EPN |
$69.50
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cigna of CA HMO |
$100.10
|
| Rate for Payer: Cigna of CA PPO |
$100.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.67
|
| Rate for Payer: United Healthcare All Other HMO |
$52.24
|
| Rate for Payer: United Healthcare HMO Rider |
$51.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Vantage Medical Group Senior |
$121.55
|
|
|
HC TRUSS ADDITION WATER PAD
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L8320
|
| Hospital Charge Code |
905358320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.83
|
| Rate for Payer: Blue Shield of California Commercial |
$119.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.73
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC TRUSS ADDITION WATER PAD
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L8320
|
| Hospital Charge Code |
905358320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC TRUSS DOUBLE W/STANDARD PADS
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT L8310
|
| Hospital Charge Code |
905358310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Adventist Health Commercial |
$159.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.31
|
| Rate for Payer: Blue Shield of California Commercial |
$287.08
|
| Rate for Payer: Blue Shield of California EPN |
$189.05
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Cigna of CA HMO |
$272.30
|
| Rate for Payer: Cigna of CA PPO |
$272.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$330.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$272.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$272.30
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: Networks By Design Commercial |
$194.50
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$233.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$233.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.99
|
| Rate for Payer: United Healthcare All Other HMO |
$142.10
|
| Rate for Payer: United Healthcare HMO Rider |
$139.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.65
|
| Rate for Payer: Vantage Medical Group Senior |
$330.65
|
|
|
HC TRUSS DOUBLE W/STANDARD PADS
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT L8310
|
| Hospital Charge Code |
905358310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Cash Price |
$213.95
|
| Rate for Payer: Cigna of CA HMO |
$272.30
|
| Rate for Payer: Cigna of CA PPO |
$272.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.36
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: Networks By Design Commercial |
$194.50
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.99
|
| Rate for Payer: United Healthcare All Other HMO |
$142.10
|
| Rate for Payer: United Healthcare HMO Rider |
$139.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.40
|
|
|
HC TRUSS SINGLE W/STANDARD PAD
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L8300
|
| Hospital Charge Code |
905358300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.84
|
| Rate for Payer: Blue Shield of California Commercial |
$133.58
|
| Rate for Payer: Blue Shield of California EPN |
$87.97
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.10
|
| 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: Molina Healthcare of CA Medi-Cal |
$126.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| 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 |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC TRUSS SINGLE W/STANDARD PAD
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L8300
|
| Hospital Charge Code |
905358300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| 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 |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC TRUWAVE DBL A-LINE CVP
|
Facility
|
OP
|
$268.66
|
|
| Hospital Charge Code |
901698617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$228.36 |
| Rate for Payer: Adventist Health Commercial |
$53.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.98
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Cigna of CA HMO |
$171.94
|
| Rate for Payer: Cigna of CA PPO |
$198.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.46
|
| Rate for Payer: EPIC Health Plan Senior |
$107.46
|
| Rate for Payer: Galaxy Health WC |
$228.36
|
| Rate for Payer: Global Benefits Group Commercial |
$161.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.06
|
| Rate for Payer: Multiplan Commercial |
$214.93
|
| Rate for Payer: Networks By Design Commercial |
$174.63
|
| Rate for Payer: Prime Health Services Commercial |
$228.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.33
|
| Rate for Payer: United Healthcare All Other HMO |
$134.33
|
| Rate for Payer: United Healthcare HMO Rider |
$134.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.36
|
| Rate for Payer: Vantage Medical Group Senior |
$228.36
|
|
|
HC TRUWAVE DBL A-LINE CVP
|
Facility
|
IP
|
$268.66
|
|
| Hospital Charge Code |
901698617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$228.36 |
| Rate for Payer: Adventist Health Commercial |
$53.73
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.46
|
| Rate for Payer: EPIC Health Plan Senior |
$107.46
|
| Rate for Payer: Galaxy Health WC |
$228.36
|
| Rate for Payer: Global Benefits Group Commercial |
$161.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.48
|
| Rate for Payer: Multiplan Commercial |
$214.93
|
| Rate for Payer: Networks By Design Commercial |
$174.63
|
| Rate for Payer: Prime Health Services Commercial |
$228.36
|
|
|
HC TRYPSIN STOOL
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.08
|
| Rate for Payer: Blue Shield of California Commercial |
$300.38
|
| Rate for Payer: Blue Shield of California EPN |
$198.46
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO |
$287.36
|
| Rate for Payer: Cigna of CA PPO |
$332.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.86
|
| Rate for Payer: EPIC Health Plan Senior |
$7.30
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Vantage Medical Group Senior |
$7.30
|
|
|
HC TRYPSIN STOOL
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.98
|
| Rate for Payer: Blue Shield of California Commercial |
$204.04
|
| Rate for Payer: Blue Shield of California EPN |
$134.81
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Cigna of CA HMO |
$195.20
|
| Rate for Payer: Cigna of CA PPO |
$225.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
905352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.46
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
905352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
915352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC T-STRAP PADDED ADDITION LE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L2270
|
| Hospital Charge Code |
915352270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.46
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TTG IGA
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGA
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC TTG IGG
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.0FR
|
Facility
|
OP
|
$983.85
|
|
| Hospital Charge Code |
900800901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.18
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
