|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.17
|
| Rate for Payer: Blue Shield of California Commercial |
$315.29
|
| Rate for Payer: Blue Shield of California Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
915355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
915355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.17
|
| Rate for Payer: Blue Shield of California Commercial |
$315.29
|
| Rate for Payer: Blue Shield of California Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
OP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$125.67
|
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.97
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.87
|
| Rate for Payer: Multiplan Commercial |
$135.86
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.91
|
| Rate for Payer: United Healthcare All Other HMO |
$84.91
|
| Rate for Payer: United Healthcare HMO Rider |
$84.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$144.35
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
IP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.76
|
| Rate for Payer: Multiplan Commercial |
$135.86
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
OP
|
$137.03
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$116.48 |
| Rate for Payer: Adventist Health Commercial |
$27.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.93
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cigna of CA HMO |
$87.70
|
| Rate for Payer: Cigna of CA PPO |
$101.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.81
|
| Rate for Payer: EPIC Health Plan Senior |
$54.81
|
| Rate for Payer: Galaxy Health WC |
$116.48
|
| Rate for Payer: Global Benefits Group Commercial |
$82.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.92
|
| Rate for Payer: Multiplan Commercial |
$109.62
|
| Rate for Payer: Networks By Design Commercial |
$89.07
|
| Rate for Payer: Prime Health Services Commercial |
$116.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.52
|
| Rate for Payer: United Healthcare All Other HMO |
$68.52
|
| Rate for Payer: United Healthcare HMO Rider |
$68.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.48
|
| Rate for Payer: Vantage Medical Group Senior |
$116.48
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
IP
|
$137.03
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$116.48 |
| Rate for Payer: Adventist Health Commercial |
$27.41
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.81
|
| Rate for Payer: EPIC Health Plan Senior |
$54.81
|
| Rate for Payer: Galaxy Health WC |
$116.48
|
| Rate for Payer: Global Benefits Group Commercial |
$82.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.89
|
| Rate for Payer: Multiplan Commercial |
$109.62
|
| Rate for Payer: Networks By Design Commercial |
$89.07
|
| Rate for Payer: Prime Health Services Commercial |
$116.48
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
IP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$52.28
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
OP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.94
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Cigna of CA HMO |
$41.82
|
| Rate for Payer: Cigna of CA PPO |
$48.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.74
|
| Rate for Payer: Multiplan Commercial |
$52.28
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.67
|
| Rate for Payer: United Healthcare All Other HMO |
$32.67
|
| Rate for Payer: United Healthcare HMO Rider |
$32.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Vantage Medical Group Senior |
$55.55
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
OP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$98.52 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.37
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cigna of CA HMO |
$74.18
|
| Rate for Payer: Cigna of CA PPO |
$85.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.13
|
| Rate for Payer: Multiplan Commercial |
$92.72
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Other HMO |
$57.95
|
| Rate for Payer: United Healthcare HMO Rider |
$57.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Vantage Medical Group Senior |
$98.52
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
IP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$98.52 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.82
|
| Rate for Payer: Multiplan Commercial |
$92.72
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$7,809.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,561.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Cigna of CA HMO |
$4,997.76
|
| Rate for Payer: Cigna of CA PPO |
$5,778.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,466.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$6,637.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,685.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,958.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,874.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$6,247.20
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$5,075.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,637.65
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,685.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,904.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,904.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,904.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,904.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
IP
|
$7,809.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,561.80 |
| Max. Negotiated Rate |
$6,637.65 |
| Rate for Payer: Adventist Health Commercial |
$1,561.80
|
| Rate for Payer: Cash Price |
$3,514.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,466.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,123.60
|
| Rate for Payer: Galaxy Health WC |
$6,637.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,685.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,958.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,607.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,874.16
|
| Rate for Payer: Multiplan Commercial |
$6,247.20
|
| Rate for Payer: Networks By Design Commercial |
$5,075.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,637.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,517.25 |
| Rate for Payer: Adventist Health Commercial |
$357.00
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,249.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.00
|
| Rate for Payer: EPIC Health Plan Senior |
$714.00
|
| Rate for Payer: Galaxy Health WC |
$1,517.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,053.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$1,428.00
|
| Rate for Payer: Networks By Design Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,517.25
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$2,368.95 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.80
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,644.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Networks By Design Commercial |
$1,811.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cigna of CA HMO |
$1,783.68
|
| Rate for Payer: Cigna of CA HMO |
$1,774.08
|
| Rate for Payer: Cigna of CA PPO |
$2,062.38
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,940.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,760.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Multiplan Commercial |
$2,217.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Networks By Design Commercial |
$1,811.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,672.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,393.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,393.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,386.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$357.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,517.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$981.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,338.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,320.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,517.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,517.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,517.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,249.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.00
|
| Rate for Payer: EPIC Health Plan Senior |
$714.00
|
| Rate for Payer: Galaxy Health WC |
$1,517.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,053.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,249.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,249.50
|
| Rate for Payer: Multiplan Commercial |
$1,428.00
|
| Rate for Payer: Networks By Design Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,517.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$892.50
|
| Rate for Payer: United Healthcare All Other HMO |
$892.50
|
| Rate for Payer: United Healthcare HMO Rider |
$892.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$892.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,517.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,517.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,517.25
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$2,368.95 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.80
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,644.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Networks By Design Commercial |
$1,811.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,788.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,254.15
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cigna of CA HMO |
$1,783.68
|
| Rate for Payer: Cigna of CA HMO |
$1,774.08
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Cigna of CA PPO |
$2,062.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,940.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,760.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Multiplan Commercial |
$2,217.60
|
| Rate for Payer: Networks By Design Commercial |
$1,811.55
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,672.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,393.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
OP
|
$5,765.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$2,594.25
|
| Rate for Payer: Cash Price |
$2,594.25
|
| Rate for Payer: Cash Price |
$2,594.25
|
| Rate for Payer: Cigna of CA HMO |
$3,689.60
|
| Rate for Payer: Cigna of CA PPO |
$4,266.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,035.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$4,900.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,660.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,383.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$4,612.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$3,747.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,900.25
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,882.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,882.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,882.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
IP
|
$5,765.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,153.00 |
| Max. Negotiated Rate |
$4,900.25 |
| Rate for Payer: Adventist Health Commercial |
$1,153.00
|
| Rate for Payer: Cash Price |
$2,594.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,035.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,306.00
|
| Rate for Payer: Galaxy Health WC |
$4,900.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,660.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,401.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,383.60
|
| Rate for Payer: Multiplan Commercial |
$4,612.00
|
| Rate for Payer: Networks By Design Commercial |
$3,747.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,900.25
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.24 |
| Max. Negotiated Rate |
$935.85 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$666.44
|
| Rate for Payer: Blue Shield of California Commercial |
$846.67
|
| Rate for Payer: Blue Shield of California Commercial |
$558.21
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$880.80
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.24
|
| Rate for Payer: Multiplan Commercial |
$880.80
|
| Rate for Payer: Networks By Design Commercial |
$715.65
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
