|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
915357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.12
|
| Rate for Payer: Multiplan Commercial |
$490.40
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.06
|
| Rate for Payer: United Healthcare All Other HMO |
$223.93
|
| Rate for Payer: United Healthcare HMO Rider |
$219.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.76
|
|
|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
905357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$521.05 |
| Rate for Payer: Adventist Health Commercial |
$251.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.05
|
| Rate for Payer: Blue Shield of California Commercial |
$471.40
|
| Rate for Payer: Blue Shield of California Commercial |
$310.79
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.10
|
| Rate for Payer: Multiplan Commercial |
$490.40
|
| Rate for Payer: Networks By Design Commercial |
$306.50
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.06
|
| Rate for Payer: United Healthcare All Other HMO |
$223.93
|
| Rate for Payer: United Healthcare HMO Rider |
$219.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.05
|
| Rate for Payer: Vantage Medical Group Senior |
$521.05
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$282.71 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cigna of CA HMO |
$3,132.80
|
| Rate for Payer: Cigna of CA PPO |
$3,622.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,426.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,937.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,549.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,447.50
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$4,160.75 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,426.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.00
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$4,160.75 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,426.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.00
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.71 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$631.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,123.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,060.80
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cigna of CA HMO |
$3,132.80
|
| Rate for Payer: Cigna of CA PPO |
$3,622.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,426.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,937.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,937.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,447.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,447.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,447.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,447.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC LIVER ELASTOGRAPHY
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 91200
|
| Hospital Charge Code |
906743912
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.31
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$207.50
|
| Rate for Payer: United Healthcare HMO Rider |
$207.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC LIVER ELASTOGRAPHY
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 91200
|
| Hospital Charge Code |
906743912
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC LIVER SPECT
|
Facility
|
IP
|
$2,376.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$2,019.60 |
| Rate for Payer: Adventist Health Commercial |
$475.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,663.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.40
|
| Rate for Payer: EPIC Health Plan Senior |
$950.40
|
| Rate for Payer: Galaxy Health WC |
$2,019.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,508.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,401.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.24
|
| Rate for Payer: Multiplan Commercial |
$1,900.80
|
| Rate for Payer: Networks By Design Commercial |
$1,544.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,019.60
|
|
|
HC LIVER SPECT
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$2,019.60 |
| Rate for Payer: Galaxy Health WC |
$2,019.60
|
| Rate for Payer: Adventist Health Commercial |
$475.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,306.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,524.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,000.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.89
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna of CA HMO |
$1,520.64
|
| Rate for Payer: Cigna of CA PPO |
$1,758.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,019.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,019.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,019.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,663.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.40
|
| Rate for Payer: EPIC Health Plan Senior |
$950.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,508.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,401.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,663.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,663.20
|
| Rate for Payer: Multiplan Commercial |
$1,900.80
|
| Rate for Payer: Networks By Design Commercial |
$1,544.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,019.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,425.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,425.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,188.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,188.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,019.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,019.60
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.60 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,262.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.20
|
| Rate for Payer: EPIC Health Plan Senior |
$721.20
|
| Rate for Payer: Galaxy Health WC |
$1,532.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,081.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,144.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,063.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,171.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,532.55
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,207.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,156.99
|
| Rate for Payer: Blue Shield of California Commercial |
$759.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.31
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Cigna of CA HMO |
$1,153.92
|
| Rate for Payer: Cigna of CA PPO |
$1,334.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,262.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,532.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,081.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,144.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,171.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,532.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,081.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,081.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Adventist Health Commercial |
$476.60
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,668.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.20
|
| Rate for Payer: EPIC Health Plan Senior |
$953.20
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,513.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,405.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.92
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.18 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Adventist Health Commercial |
$476.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$739.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,529.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,520.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.24
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cigna of CA HMO |
$1,525.12
|
| Rate for Payer: Cigna of CA PPO |
$1,763.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,668.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,513.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,820.00 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,112.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5,957.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,035.75
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,265.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,225.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,820.00 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,112.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5,957.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,035.75
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,265.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,225.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$7,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$7,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$243.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.31
|
| Rate for Payer: Blue Shield of California Commercial |
$146.51
|
| Rate for Payer: Blue Shield of California Commercial |
$222.02
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$243.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.61
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.61
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
