|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$12,216.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,443.20 |
| Max. Negotiated Rate |
$10,383.60 |
| Rate for Payer: Adventist Health Commercial |
$2,443.20
|
| Rate for Payer: Cash Price |
$5,497.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,886.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,886.40
|
| Rate for Payer: Galaxy Health WC |
$10,383.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,329.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,654.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,561.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,931.84
|
| Rate for Payer: Multiplan Commercial |
$9,772.80
|
| Rate for Payer: Networks By Design Commercial |
$7,940.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,383.60
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$12,216.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$10,383.60 |
| Rate for Payer: Adventist Health Commercial |
$2,443.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,497.20
|
| Rate for Payer: Cash Price |
$5,497.20
|
| Rate for Payer: Cash Price |
$5,497.20
|
| Rate for Payer: Cigna of CA HMO |
$7,818.24
|
| Rate for Payer: Cigna of CA PPO |
$9,039.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$10,383.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,329.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,931.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$9,772.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$7,940.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,383.60
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,329.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,108.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,108.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,108.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: EPIC Health Plan Senior |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$151.52
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$146.56 |
| Rate for Payer: Adventist Health Commercial |
$30.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.56
|
| Rate for Payer: Blue Shield of California Commercial |
$101.37
|
| Rate for Payer: Blue Shield of California EPN |
$66.97
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cigna of CA HMO |
$96.97
|
| Rate for Payer: Cigna of CA PPO |
$112.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Senior |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$128.79
|
| Rate for Payer: Global Benefits Group Commercial |
$90.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: Networks By Design Commercial |
$98.49
|
| Rate for Payer: Prime Health Services Commercial |
$128.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
915356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,524.48 |
| Max. Negotiated Rate |
$5,399.20 |
| Rate for Payer: Adventist Health Commercial |
$2,604.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,493.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,764.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,679.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4,687.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,087.07
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,156.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,446.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,446.40
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,399.20
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
905356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,270.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,420.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.48
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
905356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,524.48 |
| Max. Negotiated Rate |
$5,399.20 |
| Rate for Payer: Adventist Health Commercial |
$2,604.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,493.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,764.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,679.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4,687.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,087.07
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,156.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,446.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,446.40
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,399.20
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
915356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,270.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,420.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,931.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.48
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
905356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Multiplan Commercial |
$3,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
905356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Adventist Health Commercial |
$1,541.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,068.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,177.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,774.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,827.36
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,420.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,737.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,632.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,632.00
|
| Rate for Payer: Multiplan Commercial |
$3,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,196.00
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
915356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Adventist Health Commercial |
$1,541.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,068.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,177.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,774.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,827.36
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,420.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,737.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,632.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,632.00
|
| Rate for Payer: Multiplan Commercial |
$3,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,196.00
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
915356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Multiplan Commercial |
$3,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
OP
|
$681.03
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.21 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Adventist Health Commercial |
$136.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$446.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$578.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$374.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.22
|
| Rate for Payer: Cash Price |
$306.46
|
| Rate for Payer: Cigna of CA HMO |
$435.86
|
| Rate for Payer: Cigna of CA PPO |
$503.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$578.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$578.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$578.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.41
|
| Rate for Payer: EPIC Health Plan Senior |
$272.41
|
| Rate for Payer: Galaxy Health WC |
$578.88
|
| Rate for Payer: Global Benefits Group Commercial |
$408.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$476.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$476.72
|
| Rate for Payer: Multiplan Commercial |
$544.82
|
| Rate for Payer: Networks By Design Commercial |
$442.67
|
| Rate for Payer: Prime Health Services Commercial |
$578.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.51
|
| Rate for Payer: United Healthcare All Other HMO |
$340.51
|
| Rate for Payer: United Healthcare HMO Rider |
$340.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$578.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$578.88
|
| Rate for Payer: Vantage Medical Group Senior |
$578.88
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
IP
|
$681.03
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.21 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Adventist Health Commercial |
$136.21
|
| Rate for Payer: Cash Price |
$306.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.41
|
| Rate for Payer: EPIC Health Plan Senior |
$272.41
|
| Rate for Payer: Galaxy Health WC |
$578.88
|
| Rate for Payer: Global Benefits Group Commercial |
$408.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.45
|
| Rate for Payer: Multiplan Commercial |
$544.82
|
| Rate for Payer: Networks By Design Commercial |
$442.67
|
| Rate for Payer: Prime Health Services Commercial |
$578.88
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
OP
|
$1,696.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,441.60 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,112.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,272.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,041.51
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,187.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,187.20
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
IP
|
$1,696.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,441.60 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.04
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
OP
|
$1,951.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,658.35 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,279.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,073.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,463.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,198.11
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cigna of CA HMO |
$1,248.64
|
| Rate for Payer: Cigna of CA PPO |
$1,443.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,658.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Senior |
$780.40
|
| Rate for Payer: Galaxy Health WC |
$1,658.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,301.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,365.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,365.70
|
| Rate for Payer: Multiplan Commercial |
$1,560.80
|
| Rate for Payer: Networks By Design Commercial |
$1,268.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,658.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,170.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.50
|
| Rate for Payer: United Healthcare All Other HMO |
$975.50
|
| Rate for Payer: United Healthcare HMO Rider |
$975.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.35
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
IP
|
$1,951.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,658.35 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Senior |
$780.40
|
| Rate for Payer: Galaxy Health WC |
$1,658.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,301.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.24
|
| Rate for Payer: Multiplan Commercial |
$1,560.80
|
| Rate for Payer: Networks By Design Commercial |
$1,268.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,658.35
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
IP
|
$1,696.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,441.60 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.04
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
OP
|
$1,696.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,441.60 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,112.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,272.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,041.51
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,187.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,187.20
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$84.20 |
| Max. Negotiated Rate |
$357.85 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.40
|
| Rate for Payer: EPIC Health Plan Senior |
$168.40
|
| Rate for Payer: Galaxy Health WC |
$357.85
|
| Rate for Payer: Global Benefits Group Commercial |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.04
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: Networks By Design Commercial |
$273.65
|
| Rate for Payer: Prime Health Services Commercial |
$357.85
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.54
|
| Rate for Payer: Blue Shield of California Commercial |
$257.65
|
| Rate for Payer: Blue Shield of California EPN |
$170.08
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cigna of CA HMO |
$269.44
|
| Rate for Payer: Cigna of CA PPO |
$311.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$357.85
|
| Rate for Payer: Global Benefits Group Commercial |
$252.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: Networks By Design Commercial |
$273.65
|
| Rate for Payer: Prime Health Services Commercial |
$357.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$38.13
|
| Rate for Payer: Blue Shield of California EPN |
$25.19
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
IP
|
$1,139.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.80 |
| Max. Negotiated Rate |
$968.15 |
| Rate for Payer: Adventist Health Commercial |
$227.80
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.60
|
| Rate for Payer: EPIC Health Plan Senior |
$455.60
|
| Rate for Payer: Galaxy Health WC |
$968.15
|
| Rate for Payer: Global Benefits Group Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.36
|
| Rate for Payer: Multiplan Commercial |
$911.20
|
| Rate for Payer: Networks By Design Commercial |
$740.35
|
| Rate for Payer: Prime Health Services Commercial |
$968.15
|
|
