|
HC FX OX QUAD BRIM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$769.25 |
| Rate for Payer: Adventist Health Commercial |
$371.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$695.95
|
| Rate for Payer: Blue Shield of California Commercial |
$458.83
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$769.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$769.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$769.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$769.25
|
| Rate for Payer: Vantage Medical Group Senior |
$769.25
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
IP
|
$264.00
|
|
| Hospital Charge Code |
905353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
OP
|
$264.00
|
|
| Hospital Charge Code |
905353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.85
|
| Rate for Payer: Blue Shield of California Commercial |
$203.02
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT L3982
|
| Hospital Charge Code |
915353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT L3982
|
| Hospital Charge Code |
915353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.82
|
| Rate for Payer: Blue Shield of California Commercial |
$553.68
|
| Rate for Payer: Blue Shield of California Commercial |
$365.04
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$492.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$557.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
915352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
915352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Adventist Health Commercial |
$91.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.38
|
| Rate for Payer: Blue Shield of California Commercial |
$170.72
|
| Rate for Payer: Blue Shield of California Commercial |
$112.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
905352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Adventist Health Commercial |
$91.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.38
|
| Rate for Payer: Blue Shield of California Commercial |
$170.72
|
| Rate for Payer: Blue Shield of California Commercial |
$112.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
905352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
|
|
HC FX OX WAIST BELT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC FX OX WAIST BELT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FX OX WAIST BELT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
915352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC FX OX WAIST BELT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
915352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FX OX WRIST
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$459.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$427.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
|
|
HC FX OX WRIST
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
915353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: Adventist Health Commercial |
$296.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$438.24
|
| Rate for Payer: Blue Shield of California Commercial |
$556.76
|
| Rate for Payer: Blue Shield of California Commercial |
$367.07
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$615.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$615.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$459.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$427.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$506.80
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.40
|
| Rate for Payer: Vantage Medical Group Senior |
$615.40
|
|
|
HC FX OX WRIST
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: Adventist Health Commercial |
$296.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$438.24
|
| Rate for Payer: Blue Shield of California Commercial |
$556.76
|
| Rate for Payer: Blue Shield of California Commercial |
$367.07
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$615.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$615.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$459.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$427.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$506.80
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.40
|
| Rate for Payer: Vantage Medical Group Senior |
$615.40
|
|
|
HC FX OX WRIST
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
915353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$459.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$427.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.48
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$175.93
|
| Rate for Payer: Blue Shield of California Commercial |
$266.84
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.15
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.21
|
| Rate for Payer: Blue Shield of California Commercial |
$38.28
|
| Rate for Payer: Blue Shield of California Commercial |
$25.26
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$122.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
