|
HC SURGICAL BOOT INFANT EA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Adventist Health Commercial |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.52
|
| Rate for Payer: Blue Shield of California Commercial |
$29.67
|
| Rate for Payer: Blue Shield of California EPN |
$18.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.90
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Riverside University Health System MISP |
$14.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.93
|
| Rate for Payer: Blue Shield of California Commercial |
$72.98
|
| Rate for Payer: Blue Shield of California EPN |
$45.86
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Riverside University Health System MISP |
$36.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$72.98
|
| Rate for Payer: Blue Shield of California EPN |
$45.86
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$485.67 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Cash Price |
$242.83
|
| Rate for Payer: Central Health Plan Commercial |
$431.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$377.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.93
|
| Rate for Payer: Multiplan Commercial |
$404.72
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$485.67 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$404.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.90
|
| Rate for Payer: Blue Shield of California Commercial |
$342.13
|
| Rate for Payer: Blue Shield of California EPN |
$215.31
|
| Rate for Payer: Cash Price |
$242.83
|
| Rate for Payer: Central Health Plan Commercial |
$431.70
|
| Rate for Payer: Cigna of CA HMO |
$345.36
|
| Rate for Payer: Cigna of CA PPO |
$399.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$458.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$458.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$377.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.74
|
| Rate for Payer: Multiplan Commercial |
$404.72
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
| Rate for Payer: Riverside University Health System MISP |
$215.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.81
|
| Rate for Payer: United Healthcare All Other HMO |
$269.81
|
| Rate for Payer: United Healthcare HMO Rider |
$269.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.69
|
| Rate for Payer: Vantage Medical Group Senior |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.51
|
| Rate for Payer: Blue Shield of California Commercial |
$103.01
|
| Rate for Payer: Blue Shield of California EPN |
$64.83
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Central Health Plan Commercial |
$129.98
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$121.85
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Riverside University Health System MISP |
$64.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Central Health Plan Commercial |
$129.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Multiplan Commercial |
$121.85
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$3,568.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.60 |
| Max. Negotiated Rate |
$3,211.20 |
| Rate for Payer: Adventist Health Commercial |
$713.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,854.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,427.20
|
| Rate for Payer: Galaxy Health WC |
$3,032.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,140.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,211.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,265.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,105.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.60
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,319.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,032.80
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$3,568.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$713.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,196.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$1,727.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,075.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,854.40
|
| Rate for Payer: Cigna of CA HMO |
$2,283.52
|
| Rate for Payer: Cigna of CA PPO |
$2,640.32
|
| 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 |
$2,497.60
|
| 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 |
$3,032.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,140.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,211.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,265.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,319.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,032.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,267.84
|
| Rate for Payer: Riverside University Health System MISP |
$1,315.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,140.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,435.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,784.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SURGICAL PROCEDURE
|
Facility
|
IP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,788.80 |
| Max. Negotiated Rate |
$12,549.60 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Cash Price |
$6,274.80
|
| Rate for Payer: Central Health Plan Commercial |
$11,155.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,577.60
|
| Rate for Payer: Galaxy Health WC |
$11,852.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,549.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,854.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,226.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: Networks By Design Commercial |
$9,063.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,852.40
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,788.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,669.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,458.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,751.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,274.80
|
| Rate for Payer: Cash Price |
$6,274.80
|
| Rate for Payer: Central Health Plan Commercial |
$11,155.20
|
| Rate for Payer: Cigna of CA HMO |
$8,924.16
|
| Rate for Payer: Cigna of CA PPO |
$10,318.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,852.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,852.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,577.60
|
| Rate for Payer: Galaxy Health WC |
$11,852.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,549.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,854.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,061.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,226.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,760.80
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: Networks By Design Commercial |
$9,063.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,852.40
|
| Rate for Payer: Riverside University Health System MISP |
$5,577.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,366.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,972.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,972.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,972.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Senior |
$11,852.40
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$957.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,036.98
|
| Rate for Payer: Blue Shield of California EPN |
$653.46
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,036.98
|
| Rate for Payer: Blue Shield of California EPN |
$653.46
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,498.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,389.73
|
| Rate for Payer: Blue Shield of California EPN |
$874.61
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$1,402.88
|
| Rate for Payer: Cigna of CA PPO |
$1,622.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$112.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.40 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$876.80
|
| Rate for Payer: Galaxy Health WC |
$1,863.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,972.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,391.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: Networks By Design Commercial |
$1,424.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,863.20
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$694.23
|
| Rate for Payer: Blue Shield of California EPN |
$436.90
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,221.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.85 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,235.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,854.84
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Cigna of CA HMO |
$2,289.92
|
| Rate for Payer: Cigna of CA PPO |
$2,647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.43
|
| Rate for Payer: Blue Shield of California Commercial |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$47.88
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.65
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$9.17
|
| Rate for Payer: Prime Health Services Medicare |
$9.17
|
| Rate for Payer: Riverside University Health System MISP |
$9.52
|
| Rate for Payer: Riverside University Health System MISP |
$9.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
