|
HC LYMPHEDEMA SLEEVE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
915358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$154.79
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
915358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.27
|
| Rate for Payer: Blue Shield of California Commercial |
$154.79
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$154.79
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC LYMPHEDEMA SLEEVE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L8010
|
| Hospital Charge Code |
905358010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.27
|
| Rate for Payer: Blue Shield of California Commercial |
$154.79
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.52
|
| Rate for Payer: Blue Shield of California Commercial |
$319.20
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Riverside University Health System MISP |
$159.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$319.20
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$319.20
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
|
|
HC LYMPH EDEMA SLEEVE-CUSTOM MADE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.52
|
| Rate for Payer: Blue Shield of California Commercial |
$319.20
|
| Rate for Payer: Blue Shield of California EPN |
$200.59
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$278.60
|
| Rate for Payer: Cigna of CA PPO |
$278.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$199.00
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Riverside University Health System MISP |
$159.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.37
|
| Rate for Payer: United Healthcare All Other HMO |
$145.39
|
| Rate for Payer: United Healthcare HMO Rider |
$142.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
OP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.22 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.80
|
| Rate for Payer: Cigna of CA HMO |
$7,162.24
|
| Rate for Payer: Cigna of CA PPO |
$8,281.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$9,512.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,106.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,274.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,512.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,595.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
IP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,238.20 |
| Max. Negotiated Rate |
$10,071.90 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.40
|
| Rate for Payer: Galaxy Health WC |
$9,512.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,106.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.20
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
| Rate for Payer: Networks By Design Commercial |
$7,274.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,512.35
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
OP
|
$11,285.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.45 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,257.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,078.25
|
| Rate for Payer: Cash Price |
$5,078.25
|
| Rate for Payer: Cash Price |
$5,078.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,028.00
|
| Rate for Payer: Cigna of CA HMO |
$7,222.40
|
| Rate for Payer: Cigna of CA PPO |
$8,350.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,899.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$9,592.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,771.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,156.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,165.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,463.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,335.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,592.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,771.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,642.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$11,285.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$10,156.50 |
| Rate for Payer: Adventist Health Commercial |
$2,257.00
|
| Rate for Payer: Cash Price |
$5,078.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,028.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,899.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,514.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,514.00
|
| Rate for Payer: Galaxy Health WC |
$9,592.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,771.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,156.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,165.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,658.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.00
|
| Rate for Payer: Multiplan Commercial |
$8,463.75
|
| Rate for Payer: Networks By Design Commercial |
$7,335.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,592.25
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$11,710.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,342.00 |
| Max. Negotiated Rate |
$10,539.00 |
| Rate for Payer: Adventist Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$5,269.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,368.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,197.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,684.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.00
|
| Rate for Payer: Galaxy Health WC |
$9,953.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,539.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,435.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,908.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.00
|
| Rate for Payer: Multiplan Commercial |
$8,782.50
|
| Rate for Payer: Networks By Design Commercial |
$7,611.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,953.50
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$11,710.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,342.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,269.50
|
| Rate for Payer: Cash Price |
$5,269.50
|
| Rate for Payer: Cash Price |
$5,269.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,368.00
|
| Rate for Payer: Cigna of CA HMO |
$7,494.40
|
| Rate for Payer: Cigna of CA PPO |
$8,665.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,197.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$9,953.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,539.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,435.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,782.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,611.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$9,953.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,026.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,855.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$4,523.40 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,020.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,518.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,010.40
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,523.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,191.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,965.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.20
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.67 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,020.80
|
| Rate for Payer: Cigna of CA HMO |
$3,216.64
|
| Rate for Payer: Cigna of CA PPO |
$3,719.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,518.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,523.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$121.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,191.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,015.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,513.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Central Health Plan Commercial |
$421.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$368.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$474.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.40
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.55 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$461.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.51
|
| Rate for Payer: Blue Shield of California Commercial |
$332.01
|
| Rate for Payer: Blue Shield of California EPN |
$209.22
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Central Health Plan Commercial |
$421.60
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$368.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$474.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$461.02
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Prime Health Services Medicare |
$488.68
|
| Rate for Payer: Riverside University Health System MISP |
$507.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$290.68 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$880.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,655.73
|
| Rate for Payer: Blue Shield of California EPN |
$4,188.70
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: Cigna of CA HMO |
$6,718.72
|
| Rate for Payer: Cigna of CA PPO |
$7,768.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,348.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,666.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,298.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,298.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,099.60 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,348.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,199.20
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,666.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,193.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,099.60 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,348.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,199.20
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,666.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,193.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$10,498.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$9,448.20 |
| Rate for Payer: Adventist Health Commercial |
$2,099.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Cash Price |
$4,724.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,398.40
|
| Rate for Payer: Cigna of CA HMO |
$6,718.72
|
| Rate for Payer: Cigna of CA PPO |
$7,768.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,348.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$8,923.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,448.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,666.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$7,873.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$6,823.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$8,923.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,298.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,249.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,249.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,249.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,249.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.34
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$95.76
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Riverside University Health System MISP |
$7.37
|
| Rate for Payer: Riverside University Health System MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MAGNESIUM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,196.00 |
| Rate for Payer: Adventist Health Commercial |
$488.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,122.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,419.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,537.20
|
| Rate for Payer: Blue Shield of California EPN |
$968.68
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,952.00
|
| Rate for Payer: Cigna of CA HMO |
$1,561.60
|
| Rate for Payer: Cigna of CA PPO |
$1,805.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$2,074.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$342.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,549.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$378.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,830.00
|
| Rate for Payer: Networks By Design Commercial |
$1,586.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.00
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,464.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,464.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
