|
HC TRT DEVICES INTER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
909100210
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.18
|
| Rate for Payer: Blue Shield of California Commercial |
$668.62
|
| Rate for Payer: Blue Shield of California Commercial |
$441.21
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$670.72
|
| Rate for Payer: Cigna of CA PPO |
$775.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC TRT DEVICES INTER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
909100210
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
|
|
HC TRT DEVICES SIMPLE
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
909100209
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$580.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC TRT DEVICES SIMPLE
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
909100209
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.69 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.64
|
| Rate for Payer: Blue Shield of California Commercial |
$627.79
|
| Rate for Payer: Blue Shield of California Commercial |
$414.26
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$263.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna of CA HMO |
$410.88
|
| Rate for Payer: Cigna of CA PPO |
$475.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$545.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.40
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.70
|
| Rate for Payer: Vantage Medical Group Senior |
$545.70
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905601401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905601401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$263.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna of CA HMO |
$410.88
|
| Rate for Payer: Cigna of CA PPO |
$475.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$545.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.40
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.70
|
| Rate for Payer: Vantage Medical Group Senior |
$545.70
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$637.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$637.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$637.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$637.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.58 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cigna of CA HMO |
$1,900.80
|
| Rate for Payer: Cigna of CA PPO |
$2,197.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,079.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,885.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,376.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,485.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,079.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,188.00
|
| Rate for Payer: Galaxy Health WC |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,885.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,752.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| Rate for Payer: Multiplan Commercial |
$2,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
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: Vantage Medical Group Medi-Cal |
$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 |
$4,001.00
|
| Rate for Payer: Cash Price |
$2,805.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,364.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,959.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,263.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,678.65
|
| 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 Senior |
$5,299.75
|
|
|
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 |
$2,805.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,364.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,959.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,678.65
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$100.10
|
| Rate for Payer: Cigna of CA PPO |
$100.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.37
|
| 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 |
$92.95
|
| 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 |
$86.56
|
| Rate for Payer: Blue Shield of California Commercial |
$72.50
|
| Rate for Payer: Blue Shield of California Commercial |
$109.97
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.37
|
| 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
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L8320
|
| Hospital Charge Code |
905358320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| 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 |
$105.30
|
| 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
|
|
