|
HC LYMPHEDEMA SLEEVE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.79
|
| Rate for Payer: Blue Shield of California Commercial |
$142.43
|
| Rate for Payer: Blue Shield of California EPN |
$93.80
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
915358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.52
|
| Rate for Payer: Blue Shield of California Commercial |
$293.72
|
| Rate for Payer: Blue Shield of California EPN |
$193.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.52
|
| Rate for Payer: Blue Shield of California Commercial |
$293.72
|
| Rate for Payer: Blue Shield of California EPN |
$193.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
OP
|
$5,644.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cigna of CA HMO |
$3,612.16
|
| Rate for Payer: Cigna of CA PPO |
$4,176.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$4,797.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,386.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,764.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$4,515.20
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$3,668.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,797.40
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
IP
|
$5,644.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,128.80 |
| Max. Negotiated Rate |
$4,797.40 |
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,257.60
|
| Rate for Payer: Galaxy Health WC |
$4,797.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,386.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,764.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,493.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.56
|
| Rate for Payer: Multiplan Commercial |
$4,515.20
|
| Rate for Payer: Networks By Design Commercial |
$3,668.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,797.40
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$8,340.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,668.00 |
| Max. Negotiated Rate |
$7,089.00 |
| Rate for Payer: Adventist Health Commercial |
$1,668.00
|
| Rate for Payer: Cash Price |
$3,753.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.00
|
| Rate for Payer: Galaxy Health WC |
$7,089.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,562.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,177.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,162.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.60
|
| Rate for Payer: Multiplan Commercial |
$6,672.00
|
| Rate for Payer: Networks By Design Commercial |
$5,421.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.00
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
OP
|
$8,340.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,668.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,753.00
|
| Rate for Payer: Cash Price |
$3,753.00
|
| Rate for Payer: Cash Price |
$3,753.00
|
| Rate for Payer: Cigna of CA HMO |
$5,337.60
|
| Rate for Payer: Cigna of CA PPO |
$6,171.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$7,089.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$242.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,562.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$6,672.00
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$5,421.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.00
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,004.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$8,656.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,731.20 |
| Max. Negotiated Rate |
$7,357.60 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,462.40
|
| Rate for Payer: Galaxy Health WC |
$7,357.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,193.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,773.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,358.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,077.44
|
| Rate for Payer: Multiplan Commercial |
$6,924.80
|
| Rate for Payer: Networks By Design Commercial |
$5,626.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,357.60
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$8,656.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: Cigna of CA HMO |
$5,539.84
|
| Rate for Payer: Cigna of CA PPO |
$6,405.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$7,357.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,193.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,773.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,077.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$6,924.80
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$5,626.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,357.60
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,193.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$3,714.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.84 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cigna of CA HMO |
$2,376.96
|
| Rate for Payer: Cigna of CA PPO |
$2,748.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,228.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$3,714.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$3,156.90 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.60
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,415.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,298.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$352.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.93
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$6,625.45 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: Cigna of CA HMO |
$4,965.76
|
| Rate for Payer: Cigna of CA PPO |
$5,741.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,655.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,879.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,879.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,879.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,879.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,551.80 |
| Max. Negotiated Rate |
$6,595.15 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,103.60
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,956.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,802.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$6,625.45 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: Cigna of CA HMO |
$4,965.76
|
| Rate for Payer: Cigna of CA PPO |
$5,741.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,655.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,655.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,551.80 |
| Max. Negotiated Rate |
$6,595.15 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Cash Price |
$3,491.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,103.60
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,956.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,802.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$39.66
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$65.77 |
| Rate for Payer: Adventist Health Commercial |
$7.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.77
|
| Rate for Payer: Blue Shield of California Commercial |
$26.53
|
| Rate for Payer: Blue Shield of California EPN |
$17.53
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cigna of CA HMO |
$25.38
|
| Rate for Payer: Cigna of CA PPO |
$29.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$33.71
|
| Rate for Payer: Global Benefits Group Commercial |
$23.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$31.73
|
| Rate for Payer: Networks By Design Commercial |
$25.78
|
| Rate for Payer: Prime Health Services Commercial |
$33.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MAGNESIUM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.18
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
