|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,465.75 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,379.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6,038.26
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,780.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,442.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,086.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.80 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$1,505.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,038.26
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,780.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,442.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.80
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$4,893.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,465.75 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,379.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6,038.26
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,780.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,442.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,086.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.44
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,092.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,014.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.30 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$705.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.44
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$766.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,092.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$846.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,014.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Riverside University Health System MISP |
$688.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
915355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.30 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$705.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.44
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$766.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,092.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$846.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,014.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Riverside University Health System MISP |
$688.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
915355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.44
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,092.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,014.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,550.57 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$3,193.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,841.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,530.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,245.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,619.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,470.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,945.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,833.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,594.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,451.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$1,557.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,245.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,945.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,594.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$5,062.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
915355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,550.57 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$3,193.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,841.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,530.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,245.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,619.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,470.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,945.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,833.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,594.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,451.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
915355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Adventist Health Commercial |
$1,557.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,245.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,945.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,594.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$5,062.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
915355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,761.62 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$2,205.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,128.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,313.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,572.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,729.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,415.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,015.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,173.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,765.30
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,151.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
915355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$1,075.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,313.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,415.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,173.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.80
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$3,496.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,761.62 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$2,205.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,128.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,313.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,572.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,729.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,415.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,015.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,173.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,765.30
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,151.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$1,075.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,313.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,415.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,173.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.80
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$3,496.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,691.07 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$3,368.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,519.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,779.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6,590.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,984.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,984.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,276.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,618.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,368.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,751.90
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,286.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,984.45
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
915355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,691.07 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$3,368.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,519.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,779.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6,590.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,984.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,984.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,276.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,618.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,368.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,751.90
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,286.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,984.45
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
915355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,590.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,590.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.37
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
|
|
HC ALAIR BRONCH THERMOPLASTY CATH
|
Facility
|
OP
|
$7,813.00
|
|
|
Service Code
|
CPT C1886
|
| Hospital Charge Code |
900801886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.60 |
| Max. Negotiated Rate |
$7,031.70 |
| Rate for Payer: Adventist Health Commercial |
$1,562.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,297.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,859.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,284.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6,266.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,937.75
|
| Rate for Payer: Cash Price |
$3,515.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,250.40
|
| Rate for Payer: Cigna of CA HMO |
$5,469.10
|
| Rate for Payer: Cigna of CA PPO |
$5,469.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,641.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,641.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,469.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,125.20
|
| Rate for Payer: Galaxy Health WC |
$6,641.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,687.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,031.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,961.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,609.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,469.10
|
| Rate for Payer: Multiplan Commercial |
$5,859.75
|
| Rate for Payer: Networks By Design Commercial |
$3,906.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,641.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,125.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,687.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,687.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,932.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,854.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2,792.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,558.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,641.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,641.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,641.05
|
|
|
HC ALAIR BRONCH THERMOPLASTY CATH
|
Facility
|
IP
|
$7,813.00
|
|
|
Service Code
|
CPT C1886
|
| Hospital Charge Code |
900801886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.60 |
| Max. Negotiated Rate |
$7,031.70 |
| Rate for Payer: Adventist Health Commercial |
$1,562.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,266.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,937.75
|
| Rate for Payer: Cash Price |
$3,515.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,250.40
|
| Rate for Payer: Cigna of CA HMO |
$5,469.10
|
| Rate for Payer: Cigna of CA PPO |
$5,469.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,469.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,125.20
|
| Rate for Payer: Galaxy Health WC |
$6,641.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,687.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,031.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,961.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,609.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.60
|
| Rate for Payer: Multiplan Commercial |
$5,859.75
|
| Rate for Payer: Networks By Design Commercial |
$3,906.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,641.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,932.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,854.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2,792.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,558.76
|
|
|
HC ALBUMIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC ALBUMIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$61.74
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.17
|
| Rate for Payer: EPIC Health Plan Senior |
$5.45
|
| Rate for Payer: EPIC Health Plan Senior |
$5.45
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.25
|
| Rate for Payer: Prime Health Services Medicare |
$5.25
|
| Rate for Payer: Riverside University Health System MISP |
$5.45
|
| Rate for Payer: Riverside University Health System MISP |
$5.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$52.29 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California Commercial |
$17.01
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.84
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$8.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.25
|
| Rate for Payer: Riverside University Health System MISP |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
