|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.42
|
| Rate for Payer: Blue Shield of California Commercial |
$446.49
|
| Rate for Payer: Blue Shield of California EPN |
$294.03
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
915356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.42
|
| Rate for Payer: Blue Shield of California Commercial |
$446.49
|
| Rate for Payer: Blue Shield of California EPN |
$294.03
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Adventist Health Commercial |
$537.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.75
|
| Rate for Payer: Blue Shield of California Commercial |
$966.78
|
| Rate for Payer: Blue Shield of California EPN |
$636.66
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$877.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$917.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
915356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Adventist Health Commercial |
$537.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.75
|
| Rate for Payer: Blue Shield of California Commercial |
$966.78
|
| Rate for Payer: Blue Shield of California EPN |
$636.66
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$877.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$917.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
915356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
|
|
HC TERUMO DET CONTROLLER AZUR
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
906812570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$654.50 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$616.00
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
|
|
HC TERUMO DET CONTROLLER AZUR
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
906812570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$654.50 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$423.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$577.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.86
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna of CA HMO |
$492.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$654.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$654.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$654.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$539.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$539.00
|
| Rate for Payer: Multiplan Commercial |
$616.00
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$385.00
|
| Rate for Payer: United Healthcare All Other HMO |
$385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$654.50
|
| Rate for Payer: Vantage Medical Group Senior |
$654.50
|
|
|
HC TERUMO NAVICROSS CATHETER
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$668.95 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.88
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
|
|
HC TERUMO NAVICROSS CATHETER
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$668.95 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$516.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.30
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cigna of CA HMO |
$503.68
|
| Rate for Payer: Cigna of CA PPO |
$582.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.50
|
| Rate for Payer: United Healthcare All Other HMO |
$393.50
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC TESTICULAR SCAN
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$995.35 |
| Rate for Payer: Adventist Health Commercial |
$234.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$768.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.11
|
| Rate for Payer: Blue Shield of California Commercial |
$716.65
|
| Rate for Payer: Blue Shield of California EPN |
$473.08
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cigna of CA HMO |
$749.44
|
| Rate for Payer: Cigna of CA PPO |
$866.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC TESTICULAR SCAN
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.20 |
| Max. Negotiated Rate |
$995.35 |
| Rate for Payer: Adventist Health Commercial |
$234.20
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.40
|
| Rate for Payer: EPIC Health Plan Senior |
$468.40
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$254.95 |
| 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 |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.95
|
| 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 |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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 |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| 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 |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TEST URINE VOLUME
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.14
|
| Rate for Payer: Blue Shield of California Commercial |
$17.39
|
| Rate for Payer: Blue Shield of California EPN |
$11.49
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC TEST URINE VOLUME
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$86.70 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Senior |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.48
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC THAKO PARAPODIUM
|
Facility
|
OP
|
$6,911.00
|
|
|
Service Code
|
CPT L1500
|
| Hospital Charge Code |
905351500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.64 |
| Max. Negotiated Rate |
$5,874.35 |
| Rate for Payer: Adventist Health Commercial |
$2,833.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,874.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,801.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,183.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,002.85
|
| Rate for Payer: Blue Shield of California Commercial |
$5,100.32
|
| Rate for Payer: Blue Shield of California EPN |
$3,358.75
|
| Rate for Payer: Cash Price |
$3,109.95
|
| Rate for Payer: Cigna of CA HMO |
$4,837.70
|
| Rate for Payer: Cigna of CA PPO |
$4,837.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,874.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,874.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,874.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.40
|
| Rate for Payer: Galaxy Health WC |
$5,874.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,146.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,609.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,277.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,837.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,837.70
|
| Rate for Payer: Multiplan Commercial |
$5,528.80
|
| Rate for Payer: Networks By Design Commercial |
$3,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,874.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,146.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,146.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,593.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,524.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,469.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,263.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,874.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,874.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,874.35
|
|
|
HC THAKO PARAPODIUM
|
Facility
|
IP
|
$6,911.00
|
|
|
Service Code
|
CPT L1500
|
| Hospital Charge Code |
905351500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,382.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,382.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,109.95
|
| Rate for Payer: Cash Price |
$3,109.95
|
| Rate for Payer: Cigna of CA HMO |
$4,837.70
|
| Rate for Payer: Cigna of CA PPO |
$4,837.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.40
|
| Rate for Payer: Galaxy Health WC |
$5,874.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,146.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,609.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,277.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.64
|
| Rate for Payer: Multiplan Commercial |
$5,528.80
|
| Rate for Payer: Networks By Design Commercial |
$3,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,874.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,593.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,524.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,469.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,263.35
|
|
|
HC THAKO STANDING FRAME
|
Facility
|
IP
|
$3,546.00
|
|
|
Service Code
|
CPT L1510
|
| Hospital Charge Code |
905351510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$709.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$709.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,595.70
|
| Rate for Payer: Cash Price |
$1,595.70
|
| Rate for Payer: Cigna of CA HMO |
$2,482.20
|
| Rate for Payer: Cigna of CA PPO |
$2,482.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,418.40
|
| Rate for Payer: Galaxy Health WC |
$3,014.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,127.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,365.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,194.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$851.04
|
| Rate for Payer: Multiplan Commercial |
$2,836.80
|
| Rate for Payer: Networks By Design Commercial |
$1,773.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,014.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,330.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,295.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.32
|
|
|
HC THAKO STANDING FRAME
|
Facility
|
OP
|
$3,546.00
|
|
|
Service Code
|
CPT L1510
|
| Hospital Charge Code |
905351510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$851.04 |
| Max. Negotiated Rate |
$3,014.10 |
| Rate for Payer: Adventist Health Commercial |
$1,453.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,014.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,950.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,659.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,053.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,616.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,723.36
|
| Rate for Payer: Cash Price |
$1,595.70
|
| Rate for Payer: Cigna of CA HMO |
$2,482.20
|
| Rate for Payer: Cigna of CA PPO |
$2,482.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,014.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,014.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,014.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,418.40
|
| Rate for Payer: Galaxy Health WC |
$3,014.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,127.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,365.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,194.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$851.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,482.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,482.20
|
| Rate for Payer: Multiplan Commercial |
$2,836.80
|
| Rate for Payer: Networks By Design Commercial |
$1,773.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,014.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,127.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,127.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,330.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,295.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,014.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,014.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,014.10
|
|
|
HC THAKO SWIVEL WALKER
|
Facility
|
IP
|
$11,058.00
|
|
|
Service Code
|
CPT L1520
|
| Hospital Charge Code |
905351520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,211.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,211.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,976.10
|
| Rate for Payer: Cash Price |
$4,976.10
|
| Rate for Payer: Cigna of CA HMO |
$7,740.60
|
| Rate for Payer: Cigna of CA PPO |
$7,740.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,423.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,423.20
|
| Rate for Payer: Galaxy Health WC |
$9,399.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,634.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,375.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,213.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,844.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,653.92
|
| Rate for Payer: Multiplan Commercial |
$8,846.40
|
| Rate for Payer: Networks By Design Commercial |
$5,529.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,399.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,150.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,039.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3,952.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,621.49
|
|
|
HC THAKO SWIVEL WALKER
|
Facility
|
OP
|
$11,058.00
|
|
|
Service Code
|
CPT L1520
|
| Hospital Charge Code |
905351520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,653.92 |
| Max. Negotiated Rate |
$9,399.30 |
| Rate for Payer: Adventist Health Commercial |
$4,533.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,399.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,081.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,293.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,404.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8,160.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,374.19
|
| Rate for Payer: Cash Price |
$4,976.10
|
| Rate for Payer: Cigna of CA HMO |
$7,740.60
|
| Rate for Payer: Cigna of CA PPO |
$7,740.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,399.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,399.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,399.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,423.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,423.20
|
| Rate for Payer: Galaxy Health WC |
$9,399.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,634.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,375.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,213.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,844.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,653.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,740.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,740.60
|
| Rate for Payer: Multiplan Commercial |
$8,846.40
|
| Rate for Payer: Networks By Design Commercial |
$5,529.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,399.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,634.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,634.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,150.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,039.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3,952.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,621.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,399.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,399.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,399.30
|
|
