|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$24,948.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,211.92 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,233.23
|
| Rate for Payer: Blue Shield of California Commercial |
$29,516.53
|
| Rate for Payer: Blue Shield of California Commercial |
$19,460.18
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,211.92 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,233.23
|
| Rate for Payer: Blue Shield of California Commercial |
$29,516.53
|
| Rate for Payer: Blue Shield of California Commercial |
$19,460.18
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$24,948.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC DGP IGA
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC DGP IGA
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$68.13 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.42
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
|
|
HC DGP IGG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$68.13 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.42
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC DGP IGG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.45
|
| Rate for Payer: Blue Shield of California Commercial |
$35.50
|
| Rate for Payer: Blue Shield of California Commercial |
$55.78
|
| Rate for Payer: Blue Shield of California Commercial |
$53.67
|
| Rate for Payer: Blue Shield of California Commercial |
$84.34
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.68
|
| Rate for Payer: EPIC Health Plan Senior |
$24.45
|
| Rate for Payer: EPIC Health Plan Senior |
$24.45
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.46
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.13
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.33
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$94.08
|
| Rate for Payer: Cigna of CA PPO |
$108.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$137.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.61
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$93.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cigna of CA HMO |
$297.60
|
| Rate for Payer: Cigna of CA PPO |
$344.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$325.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$395.25
|
| Rate for Payer: Global Benefits Group Commercial |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$295.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$302.25
|
| Rate for Payer: Prime Health Services Commercial |
$395.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$279.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$93.00
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$325.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.00
|
| Rate for Payer: EPIC Health Plan Senior |
$186.00
|
| Rate for Payer: Galaxy Health WC |
$395.25
|
| Rate for Payer: Global Benefits Group Commercial |
$279.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$295.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$302.25
|
| Rate for Payer: Prime Health Services Commercial |
$395.25
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,052.60 |
| Max. Negotiated Rate |
$4,473.55 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,684.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,105.20
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,342.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,105.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.08 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO |
$3,368.32
|
| Rate for Payer: Cigna of CA PPO |
$3,894.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,684.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,342.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,052.60 |
| Max. Negotiated Rate |
$4,473.55 |
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,684.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,105.20
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,342.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,105.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO |
$3,368.32
|
| Rate for Payer: Cigna of CA PPO |
$3,894.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,684.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,342.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,631.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
IP
|
$4,814.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.80 |
| Max. Negotiated Rate |
$4,091.90 |
| Rate for Payer: Adventist Health Commercial |
$962.80
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,369.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,925.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,925.60
|
| Rate for Payer: Galaxy Health WC |
$4,091.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,888.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,056.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,840.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.36
|
| Rate for Payer: Multiplan Commercial |
$3,851.20
|
| Rate for Payer: Networks By Design Commercial |
$3,129.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,091.90
|
|
