|
HC IMMOBILIZER SHLDR ELASTIC MED
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901607802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC IMMOBILIZER SHLDR ELASTIC XL
|
Facility
|
IP
|
$83.52
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Senior |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.04
|
| Rate for Payer: Multiplan Commercial |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
|
|
HC IMMOBILIZER SHLDR ELASTIC XL
|
Facility
|
OP
|
$83.52
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Adventist Health Commercial |
$16.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.29
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cigna of CA HMO |
$53.45
|
| Rate for Payer: Cigna of CA PPO |
$61.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Senior |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.46
|
| Rate for Payer: Multiplan Commercial |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.76
|
| Rate for Payer: United Healthcare All Other HMO |
$41.76
|
| Rate for Payer: United Healthcare HMO Rider |
$41.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.99
|
| Rate for Payer: Vantage Medical Group Senior |
$70.99
|
|
|
HC IMMOBILIZER SHLDR LARGE LFT/RT
|
Facility
|
OP
|
$201.18
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698789
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$82.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.52
|
| Rate for Payer: Blue Shield of California Commercial |
$148.47
|
| Rate for Payer: Blue Shield of California EPN |
$97.77
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: EPIC Health Plan Senior |
$80.47
|
| Rate for Payer: Galaxy Health WC |
$171.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.83
|
| Rate for Payer: Multiplan Commercial |
$160.94
|
| Rate for Payer: Networks By Design Commercial |
$100.59
|
| Rate for Payer: Prime Health Services Commercial |
$171.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.49
|
| Rate for Payer: United Healthcare HMO Rider |
$71.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.00
|
| Rate for Payer: Vantage Medical Group Senior |
$171.00
|
|
|
HC IMMOBILIZER SHLDR LARGE LFT/RT
|
Facility
|
IP
|
$201.18
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698789
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Cigna of CA HMO |
$140.83
|
| Rate for Payer: Cigna of CA PPO |
$140.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.47
|
| Rate for Payer: EPIC Health Plan Senior |
$80.47
|
| Rate for Payer: Galaxy Health WC |
$171.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.28
|
| Rate for Payer: Multiplan Commercial |
$160.94
|
| Rate for Payer: Networks By Design Commercial |
$100.59
|
| Rate for Payer: Prime Health Services Commercial |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.49
|
| Rate for Payer: United Healthcare HMO Rider |
$71.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.89
|
|
|
HC IMMOBILIZER SHLDR LRG
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.08
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
|
|
HC IMMOBILIZER SHLDR LRG
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698867
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.50
|
| Rate for Payer: Blue Shield of California Commercial |
$32.49
|
| Rate for Payer: Blue Shield of California EPN |
$21.40
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$30.82
|
| Rate for Payer: Cigna of CA PPO |
$30.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.08
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC IMMOBILIZER SHLDR MED W/STRAPS
|
Facility
|
IP
|
$59.20
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Senior |
$23.68
|
| Rate for Payer: Galaxy Health WC |
$50.32
|
| Rate for Payer: Global Benefits Group Commercial |
$35.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.21
|
| Rate for Payer: Multiplan Commercial |
$47.36
|
| Rate for Payer: Networks By Design Commercial |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$50.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$21.63
|
| Rate for Payer: United Healthcare HMO Rider |
$21.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.39
|
|
|
HC IMMOBILIZER SHLDR MED W/STRAPS
|
Facility
|
OP
|
$59.20
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.69
|
| Rate for Payer: Blue Shield of California EPN |
$28.77
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cash Price |
$26.64
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Senior |
$23.68
|
| Rate for Payer: Galaxy Health WC |
$50.32
|
| Rate for Payer: Global Benefits Group Commercial |
$35.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.44
|
| Rate for Payer: Multiplan Commercial |
$47.36
|
| Rate for Payer: Networks By Design Commercial |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$50.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$21.63
|
| Rate for Payer: United Healthcare HMO Rider |
$21.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.32
|
| Rate for Payer: Vantage Medical Group Senior |
$50.32
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
IP
|
$70.93
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$14.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$49.65
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$35.47
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.62
|
| Rate for Payer: United Healthcare All Other HMO |
$25.91
|
| Rate for Payer: United Healthcare HMO Rider |
$25.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.23
|
|
|
HC IMMOBILIZER SHLDR PEDS W/SLING
|
Facility
|
OP
|
$70.93
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901698422
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Adventist Health Commercial |
$29.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.08
|
| Rate for Payer: Blue Shield of California Commercial |
$52.35
|
| Rate for Payer: Blue Shield of California EPN |
$34.47
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Cigna of CA HMO |
$49.65
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.37
|
| Rate for Payer: EPIC Health Plan Senior |
$28.37
|
| Rate for Payer: Galaxy Health WC |
$60.29
|
| Rate for Payer: Global Benefits Group Commercial |
$42.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,276.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.65
|
| Rate for Payer: Multiplan Commercial |
$56.74
|
| Rate for Payer: Networks By Design Commercial |
$35.47
|
| Rate for Payer: Prime Health Services Commercial |
$60.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.62
|
| Rate for Payer: United Healthcare All Other HMO |
$25.91
|
| Rate for Payer: United Healthcare HMO Rider |
$25.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.29
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$1,443.66 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.34
|
| Rate for Payer: Blue Shield of California Commercial |
$42.48
|
| Rate for Payer: Blue Shield of California EPN |
$27.97
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cigna of CA HMO |
$40.29
|
| Rate for Payer: Cigna of CA PPO |
$40.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,276.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.29
|
| Rate for Payer: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO |
$21.03
|
| Rate for Payer: United Healthcare HMO Rider |
$20.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.93
|
| Rate for Payer: Vantage Medical Group Senior |
$48.93
|
|
|
HC IMMOBILIZER SHOULDER ADLT W STRAPS
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
901606470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cigna of CA HMO |
$40.29
|
| Rate for Payer: Cigna of CA PPO |
$40.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| Rate for Payer: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO |
$21.03
|
| Rate for Payer: United Healthcare HMO Rider |
$20.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.85
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC IMMOBILIZER SLINGSHOT FOR OR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901604206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.94
|
| Rate for Payer: Blue Shield of California Commercial |
$428.04
|
| Rate for Payer: Blue Shield of California EPN |
$281.88
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
908710588
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
908710588
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$148.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.30
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
908710589
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.30
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.80
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54.40
|
|
|
HC IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
908710589
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$119.08
|
| Rate for Payer: Blue Shield of California EPN |
$78.68
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Senior |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$484.16 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.16
|
| Rate for Payer: Blue Shield of California Commercial |
$173.27
|
| Rate for Payer: Blue Shield of California EPN |
$114.48
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.19
|
| Rate for Payer: EPIC Health Plan Senior |
$49.03
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.72
|
| Rate for Payer: United Healthcare All Other HMO |
$39.72
|
| Rate for Payer: United Healthcare HMO Rider |
$39.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Vantage Medical Group Senior |
$49.03
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$205.41 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.41
|
| Rate for Payer: Blue Shield of California Commercial |
$111.05
|
| Rate for Payer: Blue Shield of California EPN |
$73.37
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
