|
HC COVID19 SCREEN POOL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$328.10 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$154.40
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.64
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$5,391.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,078.20 |
| Max. Negotiated Rate |
$4,582.35 |
| Rate for Payer: Adventist Health Commercial |
$1,078.20
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,773.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,156.40
|
| Rate for Payer: Galaxy Health WC |
$4,582.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,423.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,180.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.84
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: Networks By Design Commercial |
$3,504.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,582.35
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$5,391.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.54 |
| Max. Negotiated Rate |
$4,582.35 |
| Rate for Payer: Adventist Health Commercial |
$1,078.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,425.95
|
| Rate for Payer: Cigna of CA HMO |
$3,450.24
|
| Rate for Payer: Cigna of CA PPO |
$3,989.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,773.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$4,582.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,423.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: Networks By Design Commercial |
$3,504.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,582.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California Commercial |
$73.88
|
| Rate for Payer: Blue Shield of California Commercial |
$48.87
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.31 |
| Max. Negotiated Rate |
$3,164.63 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.96
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,109.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,917.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,164.63
|
| Rate for Payer: EPIC Health Plan Senior |
$2,109.76
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,145.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,759.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,685.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,416.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,570.07
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,917.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,109.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.96
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$554.20 |
| Max. Negotiated Rate |
$2,355.35 |
| Rate for Payer: Adventist Health Commercial |
$554.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,404.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,130.90
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,759.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,634.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.04
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.25
|
| Rate for Payer: United Healthcare HMO Rider |
$990.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$907.50
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,331.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,115.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,691.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Adventist Health Commercial |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,331.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,115.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,691.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,430.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
915350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,430.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$825.66
|
| Rate for Payer: United Healthcare All Other HMO |
$803.66
|
| Rate for Payer: United Healthcare HMO Rider |
$786.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.50
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$516.57
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$675.52 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$481.05
|
| Rate for Payer: Blue Shield of California Commercial |
$611.15
|
| Rate for Payer: Blue Shield of California Commercial |
$402.93
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$556.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$516.57
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
915350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$675.52 |
| Rate for Payer: Adventist Health Commercial |
$325.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$481.05
|
| Rate for Payer: Blue Shield of California Commercial |
$611.15
|
| Rate for Payer: Blue Shield of California Commercial |
$402.93
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$675.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Senior |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$556.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$556.31
|
| Rate for Payer: Multiplan Commercial |
$635.78
|
| Rate for Payer: Networks By Design Commercial |
$397.37
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.26
|
| Rate for Payer: United Healthcare All Other HMO |
$290.31
|
| Rate for Payer: United Healthcare HMO Rider |
$284.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$3,369.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,244.16 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,137.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,628.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,986.50
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
915368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$3,369.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,244.16 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Adventist Health Commercial |
$2,125.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,137.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,628.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,986.50
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,406.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,291.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,058.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,628.80
|
| Rate for Payer: Multiplan Commercial |
$4,147.20
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,893.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,852.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC CRANIAL SOCKS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC CRANIAL SOCKS
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
905380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC CRANIAL SOCKS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
915380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC CRANIAL SOCKS
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L1499
|
| Hospital Charge Code |
915380016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$46.10
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Blue Shield of California Commercial |
$69.70
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
