|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$959.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$869.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,039.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$942.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Blue Shield of California Commercial |
$30,783.17
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,676.60
|
| Rate for Payer: Networks By Design Commercial |
$24,948.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,872.80 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,327.39
|
| Rate for Payer: Blue Shield of California Commercial |
$30,783.17
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,872.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,737.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Riverside University Health System MISP |
$15,353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Blue Shield of California Commercial |
$30,783.17
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,676.60
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$24,948.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,872.80 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,327.39
|
| Rate for Payer: Blue Shield of California Commercial |
$30,783.17
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,872.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,373.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,645.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,737.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Riverside University Health System MISP |
$15,353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC DGP IGA
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC DGP IGA
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC DGP IGG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC DGP IGG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$224.83 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.83
|
| Rate for Payer: Blue Shield of California Commercial |
$48.51
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California EPN |
$30.57
|
| Rate for Payer: Blue Shield of California EPN |
$48.04
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.68
|
| Rate for Payer: EPIC Health Plan Senior |
$24.45
|
| Rate for Payer: EPIC Health Plan Senior |
$24.45
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$23.56
|
| Rate for Payer: Prime Health Services Medicare |
$23.56
|
| Rate for Payer: Riverside University Health System MISP |
$24.45
|
| Rate for Payer: Riverside University Health System MISP |
$24.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.43
|
| Rate for Payer: Blue Shield of California Commercial |
$123.63
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.14
|
| Rate for Payer: Blue Shield of California Commercial |
$140.75
|
| Rate for Payer: Blue Shield of California EPN |
$88.58
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health System MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
