|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| Rate for Payer: Adventist Health Commercial |
$544.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,225.80
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Cash Price |
$1,225.80
|
| Rate for Payer: Cash Price |
$1,225.80
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Cigna of CA HMO |
$3,097.60
|
| Rate for Payer: Cigna of CA HMO |
$1,743.36
|
| Rate for Payer: Cigna of CA PPO |
$2,015.76
|
| Rate for Payer: Cigna of CA PPO |
$3,581.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,388.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Galaxy Health WC |
$4,114.00
|
| Rate for Payer: Galaxy Health WC |
$2,315.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,634.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,073.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,729.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: Multiplan Commercial |
$3,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Networks By Design Commercial |
$1,770.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,315.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,904.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,634.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,435.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,435.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,362.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,420.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,936.00
|
| Rate for Payer: Galaxy Health WC |
$4,114.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,073.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,855.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$3,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,936.00
|
| Rate for Payer: Galaxy Health WC |
$4,114.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,073.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,855.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$3,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
|
|
HC PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Adventist Health Commercial |
$291.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,325.44
|
| Rate for Payer: Cigna of CA HMO |
$933.76
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Cigna of CA PPO |
$1,532.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,021.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$926.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$1,167.20
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$729.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
OP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$5,890.43 |
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Adventist Health Commercial |
$1,922.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$682.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cigna of CA HMO |
$3,000.32
|
| Rate for Payer: Cigna of CA PPO |
$3,469.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,976.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,837.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
IP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$937.60 |
| Max. Negotiated Rate |
$3,984.80 |
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,875.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,875.20
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,976.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,765.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
OP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$5,890.43 |
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cigna of CA HMO |
$3,000.32
|
| Rate for Payer: Cigna of CA PPO |
$3,469.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,976.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,837.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,498.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,344.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,344.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,344.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
IP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$937.60 |
| Max. Negotiated Rate |
$3,984.80 |
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,875.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,875.20
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,976.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,765.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
|
|
HC PROGESTERONE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$215.35 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.35
|
| Rate for Payer: Blue Shield of California Commercial |
$115.25
|
| Rate for Payer: Blue Shield of California Commercial |
$48.87
|
| Rate for Payer: Blue Shield of California Commercial |
$174.25
|
| Rate for Payer: Blue Shield of California Commercial |
$73.88
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.42
|
| Rate for Payer: EPIC Health Plan Senior |
$22.95
|
| Rate for Payer: EPIC Health Plan Senior |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC PROGESTERONE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$176.00
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$325.60
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.99
|
| Rate for Payer: Blue Shield of California Commercial |
$38.72
|
| Rate for Payer: Blue Shield of California Commercial |
$202.84
|
| Rate for Payer: Blue Shield of California Commercial |
$58.55
|
| Rate for Payer: Blue Shield of California Commercial |
$306.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.98
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.97
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$672.35 |
| Rate for Payer: EPIC Health Plan Senior |
$316.40
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Adventist Health Commercial |
$158.20
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$553.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.40
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$466.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$158.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cigna of CA HMO |
$506.24
|
| Rate for Payer: Cigna of CA PPO |
$585.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$553.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$395.50
|
| Rate for Payer: United Healthcare HMO Rider |
$395.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,291.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,200.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$488.16 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$833.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,525.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,564.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.24
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,728.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,291.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,200.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,423.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,423.80
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
915355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,291.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,200.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
915355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$488.16 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$833.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,525.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,564.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.24
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,728.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,291.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,200.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,423.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,423.80
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$859.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$798.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$879.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
915355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$859.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$798.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$879.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
915355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Adventist Health Commercial |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.97
|
| Rate for Payer: Blue Shield of California Commercial |
$685.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,040.46
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,150.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$859.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$798.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Adventist Health Commercial |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.97
|
| Rate for Payer: Blue Shield of California Commercial |
$685.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,040.46
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,150.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$859.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$798.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,470.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,366.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,505.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,968.60 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,401.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,781.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,174.21
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$631.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,470.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,366.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
