|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.26
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$498.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.52
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cigna of CA HMO |
$542.08
|
| Rate for Payer: Cigna of CA PPO |
$626.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.50
|
| Rate for Payer: United Healthcare All Other HMO |
$423.50
|
| Rate for Payer: United Healthcare HMO Rider |
$423.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$498.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.52
|
| Rate for Payer: Blue Shield of California Commercial |
$540.39
|
| Rate for Payer: Blue Shield of California Commercial |
$356.59
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cigna of CA HMO |
$542.08
|
| Rate for Payer: Cigna of CA PPO |
$626.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$338.80
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$338.80
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.25
|
| Rate for Payer: Blue Shield of California Commercial |
$257.75
|
| Rate for Payer: Blue Shield of California Commercial |
$170.08
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna of CA HMO |
$258.56
|
| Rate for Payer: Cigna of CA PPO |
$298.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$462.81 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.12
|
| Rate for Payer: Blue Shield of California Commercial |
$286.46
|
| Rate for Payer: Blue Shield of California Commercial |
$189.03
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$287.36
|
| Rate for Payer: Cigna of CA PPO |
$332.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.48
|
| Rate for Payer: United Healthcare All Other HMO |
$288.48
|
| Rate for Payer: United Healthcare HMO Rider |
$288.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US ABDOMINAL W CONTRAST
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$563.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$474.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC US ABDOMINAL W CONTRAST
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.57
|
| Rate for Payer: Blue Shield of California Commercial |
$338.90
|
| Rate for Payer: Blue Shield of California Commercial |
$513.59
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO |
$515.20
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$563.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$474.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$658.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$376.00
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$603.20
|
| Rate for Payer: Blue Shield of California Commercial |
$599.72
|
| Rate for Payer: Blue Shield of California Commercial |
$395.74
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna of CA HMO |
$601.60
|
| Rate for Payer: Cigna of CA PPO |
$695.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$658.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.03
|
| Rate for Payer: United Healthcare All Other HMO |
$288.03
|
| Rate for Payer: United Healthcare HMO Rider |
$288.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$658.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$376.00
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$547.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$603.20
|
| Rate for Payer: Blue Shield of California Commercial |
$599.72
|
| Rate for Payer: Blue Shield of California Commercial |
$395.74
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna of CA HMO |
$601.60
|
| Rate for Payer: Cigna of CA PPO |
$695.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$658.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.03
|
| Rate for Payer: United Healthcare All Other HMO |
$288.03
|
| Rate for Payer: United Healthcare HMO Rider |
$288.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$400.35 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.53 |
| Max. Negotiated Rate |
$400.35 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.24
|
| Rate for Payer: Blue Shield of California Commercial |
$300.50
|
| Rate for Payer: Blue Shield of California Commercial |
$198.29
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cigna of CA HMO |
$301.44
|
| Rate for Payer: Cigna of CA PPO |
$348.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$400.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$400.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$329.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$329.70
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.50
|
| Rate for Payer: United Healthcare All Other HMO |
$235.50
|
| Rate for Payer: United Healthcare HMO Rider |
$235.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.35
|
| Rate for Payer: Vantage Medical Group Senior |
$400.35
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
915355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
915355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$685.68 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$1,171.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,729.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,197.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,448.50
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,428.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,428.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,919.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,999.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,999.90
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,428.45
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
905355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
905355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$685.68 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$1,171.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,729.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,197.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,448.50
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,428.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,428.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,919.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,999.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,999.90
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,428.45
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.26
|
| Rate for Payer: Blue Shield of California Commercial |
$998.47
|
| Rate for Payer: Blue Shield of California Commercial |
$658.87
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.50
|
| Rate for Payer: United Healthcare All Other HMO |
$782.50
|
| Rate for Payer: United Healthcare HMO Rider |
$782.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$427.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$860.52
|
| Rate for Payer: Blue Shield of California Commercial |
$564.56
|
| Rate for Payer: Blue Shield of California Commercial |
$855.56
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cigna of CA HMO |
$858.24
|
| Rate for Payer: Cigna of CA PPO |
$992.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,139.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$938.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$791.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$938.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$938.70
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.50
|
| Rate for Payer: United Healthcare All Other HMO |
$670.50
|
| Rate for Payer: United Healthcare HMO Rider |
$670.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.85
|
|
