|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$10,932.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,186.40 |
| Max. Negotiated Rate |
$9,292.20 |
| Rate for Payer: Adventist Health Commercial |
$2,186.40
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,372.80
|
| Rate for Payer: Galaxy Health WC |
$9,292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,941.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,449.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,623.68
|
| Rate for Payer: Multiplan Commercial |
$8,745.60
|
| Rate for Payer: Networks By Design Commercial |
$7,105.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,292.20
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$10,932.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.32 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,012.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,199.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Cash Price |
$4,919.40
|
| Rate for Payer: Cigna of CA HMO |
$7,105.80
|
| Rate for Payer: Cigna of CA PPO |
$8,089.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,292.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,372.80
|
| Rate for Payer: Galaxy Health WC |
$9,292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,941.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,449.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,623.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,652.40
|
| Rate for Payer: Multiplan Commercial |
$8,745.60
|
| Rate for Payer: Networks By Design Commercial |
$7,105.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,292.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,292.20
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.80 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$745.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.14 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$753.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.97
|
| Rate for Payer: Blue Shield of California Commercial |
$749.01
|
| Rate for Payer: Blue Shield of California Commercial |
$494.25
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cigna of CA HMO |
$751.36
|
| Rate for Payer: Cigna of CA PPO |
$868.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$745.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.80
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$704.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$704.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$587.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$587.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.90
|
| Rate for Payer: Vantage Medical Group Senior |
$997.90
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$467.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$467.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$424.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Shield of California Commercial |
$20.28
|
| Rate for Payer: Blue Shield of California Commercial |
$119.19
|
| Rate for Payer: Blue Shield of California Commercial |
$30.67
|
| Rate for Payer: Blue Shield of California Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,212.95 |
| Rate for Payer: Adventist Health Commercial |
$285.40
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$998.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$570.80
|
| Rate for Payer: Galaxy Health WC |
$1,212.95
|
| Rate for Payer: Global Benefits Group Commercial |
$856.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$841.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.48
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Networks By Design Commercial |
$927.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.95
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$285.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Cigna of CA HMO |
$913.28
|
| Rate for Payer: Cigna of CA PPO |
$1,055.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$998.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,212.95
|
| Rate for Payer: Global Benefits Group Commercial |
$856.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$927.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.95
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$713.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC JUG R 1 (WALNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$170.73 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Blue Shield of California Commercial |
$12.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$14.79
|
| Rate for Payer: Multiplan Commercial |
$12.33
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JUG R 1 (WALNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$14.79
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC JUG R 3 (WALNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$14.79
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC JUG R 3 (WALNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$170.73 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Blue Shield of California Commercial |
$12.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$14.79
|
| Rate for Payer: Multiplan Commercial |
$12.33
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$3,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,515.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3,195.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,106.59
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,555.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,908.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
905352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,700.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$3,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,703.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,515.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3,195.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,106.59
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,531.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,531.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,555.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,759.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,908.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,908.50
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,077.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,531.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,531.75
|
|
|
HC KAFO DBL UPRIGHT AK
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
CPT L2020
|
| Hospital Charge Code |
915352020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$831.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cash Price |
$1,869.75
|
| Rate for Payer: Cigna of CA HMO |
$2,908.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,908.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.00
|
| Rate for Payer: Galaxy Health WC |
$3,531.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,638.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,451.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Multiplan Commercial |
$3,324.00
|
| Rate for Payer: Networks By Design Commercial |
$2,700.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,531.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,360.76
|
|
|
HC KAFO DBL UPRIGHT NO KNEE
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
CPT L2030
|
| Hospital Charge Code |
905352030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$435.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$435.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna of CA HMO |
$1,524.60
|
| Rate for Payer: Cigna of CA PPO |
$1,524.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$871.20
|
| Rate for Payer: Galaxy Health WC |
$1,851.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.72
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: Networks By Design Commercial |
$1,415.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,851.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.40
|
| Rate for Payer: United Healthcare All Other HMO |
$795.62
|
| Rate for Payer: United Healthcare HMO Rider |
$778.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.29
|
|
