|
HC HAST
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: EPIC Health Plan Senior |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC HAST
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$657.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.94
|
| Rate for Payer: Blue Shield of California Commercial |
$613.84
|
| Rate for Payer: Blue Shield of California EPN |
$405.21
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$618.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$579.10
|
| Rate for Payer: Blue Shield of California Commercial |
$577.12
|
| Rate for Payer: Blue Shield of California EPN |
$380.97
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$579.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$579.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$477.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Vantage Medical Group Senior |
$579.70
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$175.22 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$949.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna of CA HMO |
$926.72
|
| Rate for Payer: Cigna of CA PPO |
$1,071.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.55
|
| Rate for Payer: EPIC Health Plan Senior |
$175.22
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$234.79
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$868.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.74
|
| Rate for Payer: Vantage Medical Group Senior |
$175.22
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.20
|
| Rate for Payer: EPIC Health Plan Senior |
$579.20
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$896.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$579.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$579.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$477.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Vantage Medical Group Senior |
$579.70
|
|
|
HC HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC HCV RNA QUANT
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$151.19
|
| Rate for Payer: Blue Shield of California EPN |
$99.89
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$93.66
|
| Rate for Payer: Blue Shield of California EPN |
$61.88
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$766.32 |
| Max. Negotiated Rate |
$2,714.05 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,849.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,551.80
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$944.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$766.32 |
| Max. Negotiated Rate |
$2,714.05 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,849.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,551.80
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$944.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$897.44 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$2,215.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,052.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,129.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,987.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,625.86
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,592.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,782.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,782.10
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
915355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$897.44 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$2,215.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,052.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,129.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,987.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,625.86
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,592.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,782.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,782.10
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
915355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.28 |
| Max. Negotiated Rate |
$2,164.95 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,237.84
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,782.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.28 |
| Max. Negotiated Rate |
$2,164.95 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,237.84
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,782.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
|
