|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
915351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT CUSTOM FIT
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT L1843
|
| Hospital Charge Code |
905351843
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other HMO |
$543.57
|
| Rate for Payer: United Healthcare HMO Rider |
$531.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.32
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$533.76 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,710.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,127.57
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,648.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$533.76 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$911.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,668.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,710.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,127.57
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,890.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,890.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,648.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,863.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,556.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,112.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,890.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,890.40
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
915351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SINGLE UPRIGHT, MOLDED
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT L1844
|
| Hospital Charge Code |
905351844
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,556.80
|
| Rate for Payer: Cigna of CA PPO |
$1,556.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.67
|
| Rate for Payer: United Healthcare All Other HMO |
$812.43
|
| Rate for Payer: United Healthcare HMO Rider |
$794.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$728.36
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$338.65
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$315.36
|
| Rate for Payer: Blue Shield of California Commercial |
$400.65
|
| Rate for Payer: Blue Shield of California Commercial |
$264.15
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$315.36
|
| Rate for Payer: Blue Shield of California Commercial |
$400.65
|
| Rate for Payer: Blue Shield of California Commercial |
$264.15
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$338.65
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.71
|
| Rate for Payer: Blue Shield of California Commercial |
$625.97
|
| Rate for Payer: Blue Shield of California Commercial |
$412.70
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,009.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.71
|
| Rate for Payer: Blue Shield of California Commercial |
$625.97
|
| Rate for Payer: Blue Shield of California Commercial |
$412.70
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,009.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$6,464.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,386.80 |
| Max. Negotiated Rate |
$8,453.25 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,019.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,647.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5,042.11
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,797.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,961.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$6,464.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,386.80 |
| Max. Negotiated Rate |
$8,453.25 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,019.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,647.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5,042.11
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,797.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,961.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$7.67
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.29
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$259.05 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.05
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.23
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC LAB REF ADENOVIRUS AB TITER (CF)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
900911759
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$46.56
|
| Rate for Payer: Blue Shield of California Commercial |
$70.40
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC LAB REF ADENOVIRUS AB TITER (CF)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
900911759
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC LAB REF AEROBIC ROUTINE MIC PANEL
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
