|
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 |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| 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 |
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 |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| 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 |
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 |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| 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 |
$374.57
|
| 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 |
$374.57
|
| 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 |
$932.80
|
| 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 |
$932.80
|
| 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
|
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 |
$1,073.05
|
| 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 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 |
$1,073.05
|
| 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 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 |
$932.80
|
| 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 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 |
$932.80
|
| 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 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 |
$231.55
|
| Rate for Payer: Cash Price |
$231.55
|
| Rate for Payer: Cash Price |
$231.55
|
| 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 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 |
$231.55
|
| 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 FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| 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 |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.95
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| 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 |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| 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 |
$104.05
|
| 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 |
$37.44
|
| 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 |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| 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 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 |
$85.80
|
| 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 FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$968.15 |
| Rate for Payer: Adventist Health Commercial |
$227.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$747.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$968.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$854.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.18
|
| Rate for Payer: Blue Shield of California Commercial |
$697.07
|
| Rate for Payer: Blue Shield of California EPN |
$460.16
|
| Rate for Payer: Cash Price |
$626.45
|
| Rate for Payer: Cash Price |
$626.45
|
| Rate for Payer: Cigna of CA HMO |
$728.96
|
| Rate for Payer: Cigna of CA PPO |
$842.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$968.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$968.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$968.15
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.76
|
| 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: Molina Healthcare of CA Medi-Cal |
$797.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$797.30
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$683.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$683.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other HMO |
$569.50
|
| Rate for Payer: United Healthcare HMO Rider |
$569.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$569.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$968.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$968.15
|
| Rate for Payer: Vantage Medical Group Senior |
$968.15
|
|
|
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 |
$626.45
|
| 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
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,052.64
|
| Rate for Payer: Blue Shield of California EPN |
$694.88
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna of CA HMO |
$1,100.80
|
| Rate for Payer: Cigna of CA PPO |
$1,272.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$860.00
|
| Rate for Payer: United Healthcare All Other HMO |
$860.00
|
| Rate for Payer: United Healthcare HMO Rider |
$860.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$860.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
OP
|
$1,226.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.56 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: Adventist Health Commercial |
$245.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$804.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,042.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$674.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$919.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$750.31
|
| Rate for Payer: Blue Shield of California EPN |
$495.30
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cigna of CA HMO |
$784.64
|
| Rate for Payer: Cigna of CA PPO |
$907.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,042.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,042.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,042.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.40
|
| Rate for Payer: EPIC Health Plan Senior |
$490.40
|
| Rate for Payer: Galaxy Health WC |
$1,042.10
|
| Rate for Payer: Global Benefits Group Commercial |
$735.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$758.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$858.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$858.20
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: Networks By Design Commercial |
$796.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,042.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$735.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$735.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$613.00
|
| Rate for Payer: United Healthcare All Other HMO |
$613.00
|
| Rate for Payer: United Healthcare HMO Rider |
$613.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$613.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,042.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,042.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,042.10
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: Adventist Health Commercial |
$245.20
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.40
|
| Rate for Payer: EPIC Health Plan Senior |
$490.40
|
| Rate for Payer: Galaxy Health WC |
$1,042.10
|
| Rate for Payer: Global Benefits Group Commercial |
$735.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$758.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.24
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: Networks By Design Commercial |
$796.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,042.10
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
OP
|
$1,617.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$1,374.45 |
| Rate for Payer: Adventist Health Commercial |
$323.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,060.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,374.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$889.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,212.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$993.00
|
| Rate for Payer: Blue Shield of California Commercial |
$989.60
|
| Rate for Payer: Blue Shield of California EPN |
$653.27
|
| Rate for Payer: Cash Price |
$889.35
|
| Rate for Payer: Cigna of CA HMO |
$1,034.88
|
| Rate for Payer: Cigna of CA PPO |
$1,196.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,374.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,374.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,374.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.80
|
| Rate for Payer: EPIC Health Plan Senior |
$646.80
|
| Rate for Payer: Galaxy Health WC |
$1,374.45
|
| Rate for Payer: Global Benefits Group Commercial |
$970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,078.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,131.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,131.90
|
| Rate for Payer: Multiplan Commercial |
$1,293.60
|
| Rate for Payer: Networks By Design Commercial |
$1,051.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,374.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$970.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$970.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$808.50
|
| Rate for Payer: United Healthcare All Other HMO |
$808.50
|
| Rate for Payer: United Healthcare HMO Rider |
$808.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,374.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,374.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,374.45
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
IP
|
$1,617.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$1,374.45 |
| Rate for Payer: Cash Price |
$889.35
|
| Rate for Payer: Adventist Health Commercial |
$323.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.80
|
| Rate for Payer: EPIC Health Plan Senior |
$646.80
|
| Rate for Payer: Galaxy Health WC |
$1,374.45
|
| Rate for Payer: Global Benefits Group Commercial |
$970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,078.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.08
|
| Rate for Payer: Multiplan Commercial |
$1,293.60
|
| Rate for Payer: Networks By Design Commercial |
$1,051.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,374.45
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$884.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.51
|
| Rate for Payer: Blue Shield of California Commercial |
$825.59
|
| Rate for Payer: Blue Shield of California EPN |
$545.00
|
| Rate for Payer: Cash Price |
$741.95
|
| Rate for Payer: Cash Price |
$741.95
|
| Rate for Payer: Cigna of CA HMO |
$863.36
|
| Rate for Payer: Cigna of CA PPO |
$998.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,146.65
|
| Rate for Payer: Global Benefits Group Commercial |
$809.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: Networks By Design Commercial |
$876.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$809.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.80 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Cash Price |
$741.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$539.60
|
| Rate for Payer: Galaxy Health WC |
$1,146.65
|
| Rate for Payer: Global Benefits Group Commercial |
$809.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.76
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: Networks By Design Commercial |
$876.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.65
|
|
