|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
915351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
915351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.08 |
| Max. Negotiated Rate |
$1,572.54 |
| Rate for Payer: Adventist Health Commercial |
$703.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.15
|
| Rate for Payer: Blue Shield of California EPN |
$834.46
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,390.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,572.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.08 |
| Max. Negotiated Rate |
$1,572.54 |
| Rate for Payer: Adventist Health Commercial |
$703.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.15
|
| Rate for Payer: Blue Shield of California EPN |
$834.46
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,390.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,572.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$931.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
915351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,117.68 |
| Max. Negotiated Rate |
$3,958.45 |
| Rate for Payer: Adventist Health Commercial |
$1,909.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,697.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,436.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,263.30
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,429.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.90
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
915351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$931.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,117.68 |
| Max. Negotiated Rate |
$3,958.45 |
| Rate for Payer: Adventist Health Commercial |
$1,909.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,697.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,436.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,263.30
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cash Price |
$2,561.35
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,429.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.90
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
915352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
915352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
915355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,933.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
915355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,320.08 |
| Max. Negotiated Rate |
$8,216.95 |
| Rate for Payer: Adventist Health Commercial |
$3,963.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,599.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,134.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,698.16
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,280.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,766.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,766.90
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,933.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,320.08 |
| Max. Negotiated Rate |
$8,216.95 |
| Rate for Payer: Adventist Health Commercial |
$3,963.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,599.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,134.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,698.16
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cash Price |
$5,316.85
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,280.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,766.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,766.90
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$692.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$706.46
|
| Rate for Payer: Blue Shield of California EPN |
$466.75
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC LEUK ALK PHOS
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.92
|
| Rate for Payer: Blue Shield of California Commercial |
$330.49
|
| Rate for Payer: Blue Shield of California EPN |
$218.35
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cigna of CA HMO |
$316.16
|
| Rate for Payer: Cigna of CA PPO |
$365.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.60
|
| Rate for Payer: Galaxy Health WC |
$419.90
|
| Rate for Payer: Global Benefits Group Commercial |
$296.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Networks By Design Commercial |
$321.10
|
| Rate for Payer: Prime Health Services Commercial |
$419.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$296.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$296.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.60
|
|
|
HC LEUK ALK PHOS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.60
|
| Rate for Payer: EPIC Health Plan Senior |
$197.60
|
| Rate for Payer: Galaxy Health WC |
$419.90
|
| Rate for Payer: Global Benefits Group Commercial |
$296.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Networks By Design Commercial |
$321.10
|
| Rate for Payer: Prime Health Services Commercial |
$419.90
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.32
|
| Rate for Payer: Blue Shield of California Commercial |
$139.15
|
| Rate for Payer: Blue Shield of California EPN |
$91.94
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$113.73
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
