|
HC RED CELL SURV - SEQ
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,053.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$955.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$887.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cigna of CA HMO |
$1,087.36
|
| Rate for Payer: Cigna of CA PPO |
$1,257.26
|
| 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 Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,189.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,078.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.76
|
| 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: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$849.50
|
| Rate for Payer: United Healthcare All Other HMO |
$849.50
|
| Rate for Payer: United Healthcare HMO Rider |
$849.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$849.50
|
| 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 Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.80 |
| Max. Negotiated Rate |
$1,444.15 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,189.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,078.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,002.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.76
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Senior |
$2.39
|
| Rate for Payer: EPIC Health Plan Senior |
$2.39
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.94 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cigna of CA HMO |
$1,248.00
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,365.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,238.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$975.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,365.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Senior |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,238.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,150.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$925.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$623.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.02
|
| Rate for Payer: Blue Shield of California Commercial |
$660.55
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$513.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$466.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$433.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$881.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$513.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$466.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$513.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$466.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$433.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$881.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$513.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$466.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$700.40 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$576.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Senior |
$329.60
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$523.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$486.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,059.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna of CA HMO |
$527.36
|
| Rate for Payer: Cigna of CA PPO |
$609.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$576.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$523.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$494.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$494.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.67
|
| Rate for Payer: Blue Shield of California Commercial |
$735.16
|
| Rate for Payer: Blue Shield of California Commercial |
$484.69
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.67
|
| Rate for Payer: Blue Shield of California Commercial |
$735.16
|
| Rate for Payer: Blue Shield of California Commercial |
$484.69
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$4,879.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,481.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cigna of CA HMO |
$7,616.00
|
| Rate for Payer: Cigna of CA PPO |
$8,806.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,330.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,556.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,140.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,140.00
|
| 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 |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$2,380.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cigna of CA HMO |
$7,616.00
|
| Rate for Payer: Cigna of CA PPO |
$8,806.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,330.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,556.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,140.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,950.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$2,380.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,330.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,760.00
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,556.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,021.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$2,380.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,330.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,760.00
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,556.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,021.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
|
