|
HC DVC RESQPOD RESUSCITATOR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901605270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DVC THORACENTESIS 8FR
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901600672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Adventist Health Commercial |
$59.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.23
|
| Rate for Payer: Blue Shield of California Commercial |
$150.12
|
| Rate for Payer: Blue Shield of California Commercial |
$227.70
|
| Rate for Payer: Cash Price |
$133.24
|
| Rate for Payer: Cigna of CA HMO |
$207.27
|
| Rate for Payer: Cigna of CA PPO |
$207.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.44
|
| Rate for Payer: EPIC Health Plan Senior |
$118.44
|
| Rate for Payer: Galaxy Health WC |
$251.69
|
| Rate for Payer: Global Benefits Group Commercial |
$177.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$188.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.27
|
| Rate for Payer: Multiplan Commercial |
$236.88
|
| Rate for Payer: Networks By Design Commercial |
$148.05
|
| Rate for Payer: Prime Health Services Commercial |
$251.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.13
|
| Rate for Payer: United Healthcare All Other HMO |
$108.17
|
| Rate for Payer: United Healthcare HMO Rider |
$105.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.69
|
| Rate for Payer: Vantage Medical Group Senior |
$251.69
|
|
|
HC DVC THORACENTESIS 8FR
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901600672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$59.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$133.24
|
| Rate for Payer: Cash Price |
$133.24
|
| Rate for Payer: Cigna of CA HMO |
$207.27
|
| Rate for Payer: Cigna of CA PPO |
$207.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.44
|
| Rate for Payer: EPIC Health Plan Senior |
$118.44
|
| Rate for Payer: Galaxy Health WC |
$251.69
|
| Rate for Payer: Global Benefits Group Commercial |
$177.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$188.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.06
|
| Rate for Payer: Multiplan Commercial |
$236.88
|
| Rate for Payer: Networks By Design Commercial |
$148.05
|
| Rate for Payer: Prime Health Services Commercial |
$251.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.13
|
| Rate for Payer: United Healthcare All Other HMO |
$108.17
|
| Rate for Payer: United Healthcare HMO Rider |
$105.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.97
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$729.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$661.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$614.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$427.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$838.37
|
| 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 |
$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 |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| 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 |
$729.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$661.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| 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 |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$427.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$838.37
|
| 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 |
$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 |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| 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 |
$729.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$661.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| 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 |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$729.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$661.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$614.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DVL TST PHY/QHP PT EA ADD 30 MIN
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
900496113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Adventist Health Commercial |
$129.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$382.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$269.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC DVL TST PHY/QHP PT EA ADD 30 MIN
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
900496113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC DVL TST PHY/QHP ST EA ADD 30 MIN
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
905696113
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC DVL TST PHY/QHP ST EA ADD 30 MIN
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
905696113
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$129.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$382.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$269.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.68
|
| Rate for Payer: Blue Shield of California Commercial |
$388.35
|
| Rate for Payer: Blue Shield of California Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
915355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
915355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.68
|
| Rate for Payer: Blue Shield of California Commercial |
$388.35
|
| Rate for Payer: Blue Shield of California Commercial |
$256.04
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,250.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,026.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,845.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,815.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,250.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,026.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,845.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,815.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$222.71
|
| Rate for Payer: Blue Shield of California Commercial |
$337.50
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$1,201.90 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$834.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO |
$904.96
|
| Rate for Payer: Cigna of CA PPO |
$1,046.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$834.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$707.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$399.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$63.15
|
| Rate for Payer: Blue Shield of California Commercial |
$95.70
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
