|
HC IRON TOTAL
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.85
|
| Rate for Payer: Blue Shield of California Commercial |
$20.28
|
| Rate for Payer: Blue Shield of California Commercial |
$100.37
|
| Rate for Payer: Blue Shield of California Commercial |
$30.67
|
| Rate for Payer: Blue Shield of California Commercial |
$66.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC IRON TOTAL
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.95
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$591.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$549.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$591.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,355.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.80
|
| Rate for Payer: EPIC Health Plan Senior |
$774.80
|
| Rate for Payer: Galaxy Health WC |
$1,646.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,162.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,229.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,142.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$1,549.60
|
| Rate for Payer: Networks By Design Commercial |
$1,259.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,646.45
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Cigna of CA HMO |
$1,239.68
|
| Rate for Payer: Cigna of CA PPO |
$1,433.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,355.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,646.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,162.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,229.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,549.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,259.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,646.45
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,162.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.50
|
| Rate for Payer: United Healthcare All Other HMO |
$968.50
|
| Rate for Payer: United Healthcare HMO Rider |
$968.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$968.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.19
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.19
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.19
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.19
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
915352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.68 |
| Max. Negotiated Rate |
$622.20 |
| Rate for Payer: Adventist Health Commercial |
$300.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.08
|
| Rate for Payer: Blue Shield of California Commercial |
$562.91
|
| Rate for Payer: Blue Shield of California Commercial |
$371.12
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$622.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$464.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$431.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$512.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$439.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
915352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$464.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$431.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
905352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$464.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$431.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
905352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.68 |
| Max. Negotiated Rate |
$622.20 |
| Rate for Payer: Adventist Health Commercial |
$300.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.08
|
| Rate for Payer: Blue Shield of California Commercial |
$562.91
|
| Rate for Payer: Blue Shield of California Commercial |
$371.12
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$622.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$464.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$431.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$512.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$439.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.01
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cigna of CA HMO |
$227.20
|
| Rate for Payer: Cigna of CA PPO |
$262.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.98
|
| Rate for Payer: EPIC Health Plan Senior |
$13.32
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$225.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$142.00
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$225.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$209.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Adventist Health Commercial |
$596.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,091.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$880.71
|
| Rate for Payer: Blue Shield of California Commercial |
$737.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,118.89
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$638.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,018.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,018.50
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.75
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
915356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
|
