|
HC SOCIDEM PDC 82658
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$66.30
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.44
|
| Rate for Payer: EPIC Health Plan Senior |
$44.03
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.67
|
| Rate for Payer: United Healthcare All Other HMO |
$35.67
|
| Rate for Payer: United Healthcare HMO Rider |
$35.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$44.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Vantage Medical Group Senior |
$44.03
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.31
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$66.30
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Blue Shield of California Commercial |
$80.28
|
| Rate for Payer: Blue Shield of California EPN |
$53.04
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
OP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$474.20 |
| Max. Negotiated Rate |
$2,015.35 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,555.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,304.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,778.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,456.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,047.98
|
| Rate for Payer: Cash Price |
$1,304.05
|
| Rate for Payer: Cigna of CA HMO |
$1,517.44
|
| Rate for Payer: Cigna of CA PPO |
$1,754.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,015.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,015.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$948.40
|
| Rate for Payer: Galaxy Health WC |
$2,015.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,422.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,467.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,659.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,659.70
|
| Rate for Payer: Multiplan Commercial |
$1,896.80
|
| Rate for Payer: Networks By Design Commercial |
$1,541.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,015.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,422.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,422.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,185.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,185.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,185.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,015.35
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
IP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$474.20 |
| Max. Negotiated Rate |
$2,015.35 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Cash Price |
$1,304.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$948.40
|
| Rate for Payer: Galaxy Health WC |
$2,015.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,422.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,581.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,467.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.04
|
| Rate for Payer: Multiplan Commercial |
$1,896.80
|
| Rate for Payer: Networks By Design Commercial |
$1,541.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,015.35
|
|
|
HC SOCKET INSERT W LOCK MECH
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
915340556
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.92 |
| Max. Negotiated Rate |
$963.05 |
| Rate for Payer: Adventist Health Commercial |
$464.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$656.23
|
| Rate for Payer: Blue Shield of California Commercial |
$836.15
|
| Rate for Payer: Blue Shield of California EPN |
$550.64
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$963.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$963.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$963.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$793.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$793.10
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: Networks By Design Commercial |
$566.50
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$963.05
|
| Rate for Payer: Vantage Medical Group Senior |
$963.05
|
|
|
HC SOCKET INSERT W LOCK MECH
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
915340556
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.92
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: Networks By Design Commercial |
$566.50
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
|
|
HC SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
915340557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.92
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: Networks By Design Commercial |
$566.50
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
|
|
HC SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
915340557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$271.92 |
| Max. Negotiated Rate |
$963.05 |
| Rate for Payer: Adventist Health Commercial |
$464.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$656.23
|
| Rate for Payer: Blue Shield of California Commercial |
$836.15
|
| Rate for Payer: Blue Shield of California EPN |
$550.64
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cigna of CA HMO |
$793.10
|
| Rate for Payer: Cigna of CA PPO |
$793.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$963.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$963.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$963.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$703.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$793.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$793.10
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: Networks By Design Commercial |
$566.50
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.21
|
| Rate for Payer: United Healthcare All Other HMO |
$413.88
|
| Rate for Payer: United Healthcare HMO Rider |
$404.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$963.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$963.05
|
| Rate for Payer: Vantage Medical Group Senior |
$963.05
|
|
|
HC SO DBL SHLDR ELASTIC PRE-FAB
|
Facility
|
IP
|
$284.00
|
|
| Hospital Charge Code |
905353652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC SO DBL SHLDR ELASTIC PRE-FAB
|
Facility
|
OP
|
$284.00
|
|
| Hospital Charge Code |
905353652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.40
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.80
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.00
|
| Rate for Payer: United Healthcare All Other HMO |
$142.00
|
| Rate for Payer: United Healthcare HMO Rider |
$142.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC SODIUM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$75.65 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: EPIC Health Plan Senior |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC SODIUM
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$75.65 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.35
|
| Rate for Payer: Blue Shield of California Commercial |
$59.54
|
| Rate for Payer: Blue Shield of California EPN |
$39.34
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM BODY FLUID
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.81
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SODIUM CH
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SODIUM CH
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.35
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,588.65 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.32
|
| Rate for Payer: Blue Shield of California EPN |
$908.33
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cigna of CA HMO |
$1,308.30
|
| Rate for Payer: Cigna of CA PPO |
$1,308.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.56
|
| Rate for Payer: Multiplan Commercial |
$1,495.20
|
| Rate for Payer: Networks By Design Commercial |
$934.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.44
|
| Rate for Payer: United Healthcare All Other HMO |
$682.75
|
| Rate for Payer: United Healthcare HMO Rider |
$667.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.10
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,588.65 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.75
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cigna of CA HMO |
$1,308.30
|
| Rate for Payer: Cigna of CA PPO |
$1,308.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,588.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,308.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,308.30
|
| Rate for Payer: Multiplan Commercial |
$1,495.20
|
| Rate for Payer: Networks By Design Commercial |
$934.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.44
|
| Rate for Payer: United Healthcare All Other HMO |
$682.75
|
| Rate for Payer: United Healthcare HMO Rider |
$667.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC SODIUM STOOL
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.81
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$79.12
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM STOOL
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
