|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
|
IP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
HC WOUND CROWN- FISTULA MGMT
|
Facility
|
IP
|
$382.80
|
|
| Hospital Charge Code |
901608082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.87
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
|
|
HC WOUND CROWN- FISTULA MGMT
|
Facility
|
OP
|
$382.80
|
|
| Hospital Charge Code |
901608082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.08
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.96
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
OP
|
$9,336.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$7,935.60 |
| Rate for Payer: Adventist Health Commercial |
$1,867.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$5,134.80
|
| Rate for Payer: Cash Price |
$5,134.80
|
| Rate for Payer: Cash Price |
$5,134.80
|
| Rate for Payer: Cigna of CA HMO |
$5,975.04
|
| Rate for Payer: Cigna of CA PPO |
$6,908.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$7,935.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,601.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,227.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,240.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$7,468.80
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$6,068.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,935.60
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,668.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,668.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,668.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,668.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
IP
|
$9,336.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,867.20 |
| Max. Negotiated Rate |
$7,935.60 |
| Rate for Payer: Adventist Health Commercial |
$1,867.20
|
| Rate for Payer: Cash Price |
$5,134.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,734.40
|
| Rate for Payer: Galaxy Health WC |
$7,935.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,601.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,227.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,557.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,778.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,240.64
|
| Rate for Payer: Multiplan Commercial |
$7,468.80
|
| Rate for Payer: Networks By Design Commercial |
$6,068.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,935.60
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
OP
|
$7,987.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$6,788.95 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Cigna of CA HMO |
$5,111.68
|
| Rate for Payer: Cigna of CA PPO |
$5,910.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$6,788.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,792.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,916.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,389.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,191.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,788.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,792.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,993.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,993.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,993.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,993.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
IP
|
$7,987.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,597.40 |
| Max. Negotiated Rate |
$6,788.95 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,194.80
|
| Rate for Payer: Galaxy Health WC |
$6,788.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,792.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,043.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,943.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,916.88
|
| Rate for Payer: Multiplan Commercial |
$6,389.60
|
| Rate for Payer: Networks By Design Commercial |
$5,191.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,788.95
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$383.35 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: EPIC Health Plan Senior |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$338.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: Cigna of CA HMO |
$288.64
|
| Rate for Payer: Cigna of CA PPO |
$333.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$383.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: EPIC Health Plan Senior |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$305.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.70
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Vantage Medical Group Senior |
$383.35
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.88
|
| Rate for Payer: Blue Shield of California Commercial |
$476.14
|
| Rate for Payer: Blue Shield of California EPN |
$314.31
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: Cigna of CA HMO |
$497.92
|
| Rate for Payer: Cigna of CA PPO |
$575.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC WRIST LIMITED
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$423.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$395.35
|
| Rate for Payer: Blue Shield of California EPN |
$260.98
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC WRIST LIMITED
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Senior |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$399.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
|
HC WRIST WRAP (L/U)
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901603171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC WRIST WRAP (L/U)
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901603171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC WRIST WRAP (R/U)
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901603170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC WRIST WRAP (R/U)
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901603170
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.85
|
| Rate for Payer: Blue Shield of California Commercial |
$82.29
|
| Rate for Payer: Blue Shield of California EPN |
$54.37
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$447.66 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.91
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$141.70
|
| Rate for Payer: Blue Shield of California EPN |
$93.31
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$265.31 |
| Max. Negotiated Rate |
$1,376.15 |
| Rate for Payer: Adventist Health Commercial |
$323.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,061.90
|
| 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 |
$1,236.98
|
| Rate for Payer: Blue Shield of California Commercial |
$990.83
|
| Rate for Payer: Blue Shield of California EPN |
$654.08
|
| Rate for Payer: Cash Price |
$890.45
|
| Rate for Payer: Cash Price |
$890.45
|
| Rate for Payer: Cigna of CA HMO |
$1,036.16
|
| Rate for Payer: Cigna of CA PPO |
$1,198.06
|
| 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 |
$1,376.15
|
| Rate for Payer: Global Benefits Group Commercial |
$971.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,079.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.56
|
| 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 |
$1,295.20
|
| Rate for Payer: Networks By Design Commercial |
$1,052.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,376.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$971.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$971.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.19
|
| Rate for Payer: United Healthcare All Other HMO |
$518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$518.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.19
|
| 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 XENON PERFUSION SCAN
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$323.80 |
| Max. Negotiated Rate |
$1,376.15 |
| Rate for Payer: Adventist Health Commercial |
$323.80
|
| Rate for Payer: Cash Price |
$890.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$647.60
|
| Rate for Payer: EPIC Health Plan Senior |
$647.60
|
| Rate for Payer: Galaxy Health WC |
$1,376.15
|
| Rate for Payer: Global Benefits Group Commercial |
$971.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,079.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.56
|
| Rate for Payer: Multiplan Commercial |
$1,295.20
|
| Rate for Payer: Networks By Design Commercial |
$1,052.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,376.15
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$2,172.60 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,405.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,480.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,886.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,242.22
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.20
|
| Rate for Payer: Cigna of CA PPO |
$1,789.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,172.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,704.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,582.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,789.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,789.20
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: Networks By Design Commercial |
$1,278.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,533.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$959.27
|
| Rate for Payer: United Healthcare All Other HMO |
$933.71
|
| Rate for Payer: United Healthcare HMO Rider |
$913.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,172.60
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.20
|
| Rate for Payer: Cigna of CA PPO |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,022.40
|
| Rate for Payer: Galaxy Health WC |
$2,172.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,533.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,704.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,582.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.44
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: Networks By Design Commercial |
$1,278.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,172.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$959.27
|
| Rate for Payer: United Healthcare All Other HMO |
$933.71
|
| Rate for Payer: United Healthcare HMO Rider |
$913.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.09
|
|
