|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,751.12 |
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$39.65
|
| Rate for Payer: Blue Shield of California Commercial |
$59.94
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$2,701.73 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,701.73
|
| Rate for Payer: Blue Shield of California Commercial |
$129.64
|
| Rate for Payer: Blue Shield of California Commercial |
$85.75
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BCID2
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC BCID2
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$1,288.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,288.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Vantage Medical Group Senior |
$218.06
|
| Rate for Payer: Vantage Medical Group Senior |
$218.06
|
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,288.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.04
|
| Rate for Payer: Blue Shield of California Commercial |
$122.17
|
| Rate for Payer: Blue Shield of California Commercial |
$101.42
|
| Rate for Payer: Blue Shield of California Commercial |
$184.71
|
| Rate for Payer: Blue Shield of California Commercial |
$153.34
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.80
|
| Rate for Payer: EPIC Health Plan Senior |
$239.87
|
| Rate for Payer: EPIC Health Plan Senior |
$239.87
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$218.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$414.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$414.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.20
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.62
|
| Rate for Payer: United Healthcare All Other HMO |
$176.62
|
| Rate for Payer: United Healthcare All Other HMO |
$176.62
|
| Rate for Payer: United Healthcare HMO Rider |
$176.62
|
| Rate for Payer: United Healthcare HMO Rider |
$176.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$218.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$218.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.09
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$265.00 |
| Max. Negotiated Rate |
$1,126.25 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.00
|
| Rate for Payer: EPIC Health Plan Senior |
$530.00
|
| Rate for Payer: Galaxy Health WC |
$1,126.25
|
| Rate for Payer: Global Benefits Group Commercial |
$795.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$841.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$781.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: Networks By Design Commercial |
$861.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,126.25
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$569.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$850.25
|
| Rate for Payer: Blue Shield of California Commercial |
$557.83
|
| Rate for Payer: Blue Shield of California Commercial |
$845.35
|
| Rate for Payer: Blue Shield of California Commercial |
$373.85
|
| Rate for Payer: Blue Shield of California Commercial |
$566.54
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA HMO |
$848.00
|
| Rate for Payer: Cigna of CA HMO |
$568.32
|
| Rate for Payer: Cigna of CA PPO |
$980.50
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$927.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Galaxy Health WC |
$1,126.25
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Global Benefits Group Commercial |
$795.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$841.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Networks By Design Commercial |
$861.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,126.25
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$795.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$795.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.50
|
| Rate for Payer: United Healthcare HMO Rider |
$444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
915356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$970.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Adventist Health Commercial |
$1,657.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,223.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,032.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,447.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,109.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,049.80
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,436.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,436.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,424.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,741.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,385.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,830.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,830.10
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,436.55
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
905356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$970.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Adventist Health Commercial |
$1,657.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,223.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,032.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,447.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,109.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,049.80
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,436.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,436.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,424.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,741.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,385.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,830.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,830.10
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,436.55
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
905356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,385.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
915356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,385.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
915356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,679.68 |
| Max. Negotiated Rate |
$13,032.20 |
| Rate for Payer: Adventist Health Commercial |
$6,286.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,432.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,499.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,280.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,773.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11,790.31
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,032.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,032.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,174.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,735.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,982.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,045.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,732.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,732.40
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13,032.20
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
915356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,066.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,066.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,735.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,045.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$9,965.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
905356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,679.68 |
| Max. Negotiated Rate |
$13,032.20 |
| Rate for Payer: Adventist Health Commercial |
$6,286.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,432.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,499.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,280.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,773.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11,790.31
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,032.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,032.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,174.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,735.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,982.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,045.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,732.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,732.40
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13,032.20
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
905356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,066.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,066.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,735.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,045.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$9,965.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
OP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
905356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,796.16 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$8,193.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,991.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,988.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,096.32
|
| Rate for Payer: Blue Shield of California Commercial |
$15,367.70
|
| Rate for Payer: Blue Shield of California Commercial |
$10,131.89
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,986.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,036.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,689.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,957.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,790.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,988.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,988.80
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16,986.40
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
OP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
915356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,796.16 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$8,193.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,991.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,988.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,096.32
|
| Rate for Payer: Blue Shield of California Commercial |
$15,367.70
|
| Rate for Payer: Blue Shield of California Commercial |
$10,131.89
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,986.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,036.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,689.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,957.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,790.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,988.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,988.80
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16,986.40
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
IP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
915356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,996.80 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$3,996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,689.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,790.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$12,989.60
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
IP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
905356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,996.80 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$3,996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,689.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,790.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$12,989.60
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$681.70 |
| Rate for Payer: Adventist Health Commercial |
$160.40
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$561.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Senior |
$320.80
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$509.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$473.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.48
|
| Rate for Payer: Multiplan Commercial |
$641.60
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
|
