|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
IP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Central Health Plan Commercial |
$92.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$86.92
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
IP
|
$15,482.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,096.40 |
| Max. Negotiated Rate |
$13,933.80 |
| Rate for Payer: Adventist Health Commercial |
$3,096.40
|
| Rate for Payer: Cash Price |
$6,966.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,385.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,837.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,192.80
|
| Rate for Payer: Galaxy Health WC |
$13,159.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,933.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,831.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,134.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,096.40
|
| Rate for Payer: Multiplan Commercial |
$11,611.50
|
| Rate for Payer: Networks By Design Commercial |
$10,063.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,159.70
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$15,482.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$13,933.80 |
| Rate for Payer: Adventist Health Commercial |
$3,096.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$6,966.90
|
| Rate for Payer: Cash Price |
$6,966.90
|
| Rate for Payer: Cash Price |
$6,966.90
|
| Rate for Payer: Cash Price |
$6,966.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,385.60
|
| Rate for Payer: Cigna of CA HMO |
$9,908.48
|
| Rate for Payer: Cigna of CA PPO |
$11,456.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,837.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$13,159.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,933.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,831.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,096.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$11,611.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$10,063.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$13,159.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,741.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,741.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,741.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,741.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,105.40 |
| Max. Negotiated Rate |
$4,974.30 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,421.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,868.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.80
|
| Rate for Payer: Galaxy Health WC |
$4,697.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,974.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,509.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,260.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.40
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: Networks By Design Commercial |
$3,592.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.95
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,105.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,342.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,676.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,215.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,612.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| 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: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,421.60
|
| Rate for Payer: Cigna of CA HMO |
$1,774.08
|
| Rate for Payer: Cigna of CA HMO |
$3,537.28
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Cigna of CA PPO |
$4,089.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,940.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,868.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Galaxy Health WC |
$4,697.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,974.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,494.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,509.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,760.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: Multiplan Commercial |
$2,079.00
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Networks By Design Commercial |
$3,592.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,316.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$4,974.30 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Adventist Health Commercial |
$554.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,217.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,421.60
|
| Rate for Payer: Cigna of CA HMO |
$1,774.08
|
| Rate for Payer: Cigna of CA HMO |
$3,537.28
|
| Rate for Payer: Cigna of CA PPO |
$4,089.98
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,940.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,868.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,697.95
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,974.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,494.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,509.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,760.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: Multiplan Commercial |
$2,079.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Networks By Design Commercial |
$3,592.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,763.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,386.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,763.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,763.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,386.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$906.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,236.75
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,319.20
|
| Rate for Payer: Cigna of CA HMO |
$1,055.36
|
| Rate for Payer: Cigna of CA PPO |
$1,220.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,401.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,401.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,154.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Senior |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,484.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,047.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$598.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$972.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,154.30
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
| Rate for Payer: Riverside University Health System MISP |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$989.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,319.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,154.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Senior |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,484.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,047.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$972.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,105.40 |
| Max. Negotiated Rate |
$4,974.30 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,421.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,868.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.80
|
| Rate for Payer: Galaxy Health WC |
$4,697.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,974.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,509.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,260.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.40
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: Networks By Design Commercial |
$3,592.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.95
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
IP
|
$11,429.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,285.80 |
| Max. Negotiated Rate |
$10,286.10 |
| Rate for Payer: Adventist Health Commercial |
$2,285.80
|
| Rate for Payer: Cash Price |
$5,143.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,143.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,000.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,571.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,571.60
|
| Rate for Payer: Galaxy Health WC |
$9,714.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,857.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,286.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,257.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,743.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,285.80
|
| Rate for Payer: Multiplan Commercial |
$8,571.75
|
| Rate for Payer: Networks By Design Commercial |
$7,428.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,714.65
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
OP
|
$11,429.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$10,286.10 |
| Rate for Payer: Adventist Health Commercial |
$2,285.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$5,143.05
|
| Rate for Payer: Cash Price |
$5,143.05
|
| Rate for Payer: Cash Price |
$5,143.05
|
| Rate for Payer: Cash Price |
$5,143.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,143.20
|
| Rate for Payer: Cigna of CA HMO |
$7,314.56
|
| Rate for Payer: Cigna of CA PPO |
$8,457.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,000.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$9,714.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,857.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,286.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,257.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,285.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$8,571.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$7,428.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$9,714.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,857.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,714.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,714.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,714.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,714.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ADJ TISSUE TRNSF TRUNK 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,811.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
900501140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,162.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,648.80
|
| Rate for Payer: Cigna of CA HMO |
$3,719.04
|
| Rate for Payer: Cigna of CA PPO |
$4,300.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,067.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$4,939.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,486.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,229.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,689.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,162.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$4,358.25
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$3,777.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$4,939.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,486.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,905.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ADJ TISSUE TRNSF TRUNK 10 SQ CM OR LESS
|
Facility
|
IP
|
$5,811.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
900501140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,162.20 |
| Max. Negotiated Rate |
$5,229.90 |
| Rate for Payer: Adventist Health Commercial |
$1,162.20
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,648.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,067.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,324.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.40
|
| Rate for Payer: Galaxy Health WC |
$4,939.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,486.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,229.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,689.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,428.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,162.20
|
| Rate for Payer: Multiplan Commercial |
$4,358.25
|
| Rate for Payer: Networks By Design Commercial |
$3,777.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,939.35
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$883.00
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$715.65
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC ADJT JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915361832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.58 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$640.45
|
| Rate for Payer: Blue Shield of California Commercial |
$883.00
|
| Rate for Payer: Blue Shield of California EPN |
$554.90
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Riverside University Health System MISP |
$440.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC ADJUSTABLE MOBILE ARM SUPPORT
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT L3964
|
| Hospital Charge Code |
903203964
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$995.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,394.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$902.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$794.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$953.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.76
|
| Rate for Payer: Blue Shield of California EPN |
$654.36
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,312.00
|
| Rate for Payer: Cigna of CA HMO |
$1,049.60
|
| Rate for Payer: Cigna of CA PPO |
$1,213.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,394.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,394.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,394.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$656.00
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,476.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,041.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$967.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,148.00
|
| Rate for Payer: Multiplan Commercial |
$1,230.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
| Rate for Payer: Riverside University Health System MISP |
$656.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$984.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,394.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,394.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,394.00
|
|
|
HC ADJUSTABLE MOBILE ARM SUPPORT
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT L3964
|
| Hospital Charge Code |
903203964
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,312.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$656.00
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,476.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,041.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$967.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.00
|
| Rate for Payer: Multiplan Commercial |
$1,230.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$155.33
|
| Rate for Payer: Blue Shield of California EPN |
$97.75
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health System MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC ADM FR H-COMP A/D SAME/ HR
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC ADM FR H-COMP A/D SAME/ HR
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$170.55
|
| Rate for Payer: Blue Shield of California EPN |
$107.33
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.30
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Riverside University Health System MISP |
$107.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.65
|
| Rate for Payer: Vantage Medical Group Senior |
$228.65
|
|
|
HC ADM FR HIGH A/D 2DATES/ HR
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$170.55
|
| Rate for Payer: Blue Shield of California EPN |
$107.33
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.30
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Riverside University Health System MISP |
$107.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.65
|
| Rate for Payer: Vantage Medical Group Senior |
$228.65
|
|
|
HC ADM FR HIGH A/D 2DATES/ HR
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC ADM FR LOW A/D 2 DATES/ HR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
902100001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$155.33
|
| Rate for Payer: Blue Shield of California EPN |
$97.75
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health System MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC ADM FR LOW A/D 2 DATES/ HR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
902100001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
