|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$9,147.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,829.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Adventist Health Commercial |
$1,694.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Cigna of CA HMO |
$5,420.80
|
| Rate for Payer: Cigna of CA HMO |
$5,854.08
|
| Rate for Payer: Cigna of CA PPO |
$6,267.80
|
| Rate for Payer: Cigna of CA PPO |
$6,768.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,402.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,929.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$7,199.50
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,082.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,378.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,808.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Multiplan Commercial |
$6,776.00
|
| Rate for Payer: Networks By Design Commercial |
$5,505.50
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,199.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,488.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,082.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,573.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
IP
|
$9,147.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,829.40 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.80
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,808.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,396.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$3,093.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Adventist Health Commercial |
$618.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Cigna of CA HMO |
$1,979.52
|
| Rate for Payer: Cigna of CA PPO |
$2,288.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,165.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$2,629.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,855.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$309.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,964.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,474.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,010.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,629.05
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,855.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,546.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$3,093.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$618.60 |
| Max. Negotiated Rate |
$2,629.05 |
| Rate for Payer: Adventist Health Commercial |
$618.60
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,165.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,237.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,237.20
|
| Rate for Payer: Galaxy Health WC |
$2,629.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,855.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,964.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,824.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.32
|
| Rate for Payer: Multiplan Commercial |
$2,474.40
|
| Rate for Payer: Networks By Design Commercial |
$2,010.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,629.05
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$436.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cigna of CA HMO |
$1,397.76
|
| Rate for Payer: Cigna of CA PPO |
$1,616.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,528.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$1,856.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,310.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$999.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,130.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,419.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,856.40
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,310.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,092.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$1,856.40 |
| Rate for Payer: Adventist Health Commercial |
$436.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,528.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Senior |
$873.60
|
| Rate for Payer: Galaxy Health WC |
$1,856.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,310.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,288.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.16
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: Networks By Design Commercial |
$1,419.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,856.40
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$3,527.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$705.40 |
| Max. Negotiated Rate |
$2,997.95 |
| Rate for Payer: Adventist Health Commercial |
$705.40
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.80
|
| Rate for Payer: Galaxy Health WC |
$2,997.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,239.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,080.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.48
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: Networks By Design Commercial |
$2,292.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,997.95
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$3,527.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Galaxy Health WC |
$2,997.95
|
| Rate for Payer: Adventist Health Commercial |
$705.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Cash Price |
$1,587.15
|
| Rate for Payer: Cigna of CA HMO |
$2,257.28
|
| Rate for Payer: Cigna of CA PPO |
$2,609.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,116.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$308.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,239.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,292.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,997.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,116.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,763.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$47.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Blue Shield of California Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.97
|
| Rate for Payer: EPIC Health Plan Senior |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.89
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.95
|
| Rate for Payer: United Healthcare All Other HMO |
$28.95
|
| Rate for Payer: United Healthcare HMO Rider |
$28.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
OP
|
$155.26
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.26 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$63.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.98
|
| Rate for Payer: Blue Shield of California Commercial |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$119.39
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$108.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.10
|
| Rate for Payer: EPIC Health Plan Senior |
$62.10
|
| Rate for Payer: Galaxy Health WC |
$131.97
|
| Rate for Payer: Global Benefits Group Commercial |
$93.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.68
|
| Rate for Payer: Multiplan Commercial |
$124.21
|
| Rate for Payer: Networks By Design Commercial |
$77.63
|
| Rate for Payer: Prime Health Services Commercial |
$131.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.27
|
| Rate for Payer: United Healthcare All Other HMO |
$56.72
|
| Rate for Payer: United Healthcare HMO Rider |
$55.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.97
|
| Rate for Payer: Vantage Medical Group Senior |
$131.97
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
IP
|
$155.26
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$108.68
|
| Rate for Payer: Cash Price |
$69.87
|
| Rate for Payer: Adventist Health Commercial |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.10
|
| Rate for Payer: EPIC Health Plan Senior |
$62.10
|
| Rate for Payer: Galaxy Health WC |
$131.97
|
| Rate for Payer: Global Benefits Group Commercial |
$93.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.26
|
| Rate for Payer: Multiplan Commercial |
$124.21
|
| Rate for Payer: Networks By Design Commercial |
$100.92
|
| Rate for Payer: Prime Health Services Commercial |
$131.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.27
|
| Rate for Payer: United Healthcare All Other HMO |
$56.72
|
| Rate for Payer: United Healthcare HMO Rider |
$55.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.85
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
OP
|
$95.61
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.87
|
| Rate for Payer: Blue Shield of California Commercial |
$73.52
|
| Rate for Payer: Blue Shield of California Commercial |
$48.47
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cigna of CA HMO |
$66.93
|
| Rate for Payer: Cigna of CA PPO |
$66.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.24
|
| Rate for Payer: EPIC Health Plan Senior |
$38.24
|
| Rate for Payer: Galaxy Health WC |
$81.27
|
| Rate for Payer: Global Benefits Group Commercial |
$57.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.93
|
| Rate for Payer: Multiplan Commercial |
$76.49
|
| Rate for Payer: Networks By Design Commercial |
$47.80
|
| Rate for Payer: Prime Health Services Commercial |
$81.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Other HMO |
$34.93
|
| Rate for Payer: United Healthcare HMO Rider |
$34.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.27
|
| Rate for Payer: Vantage Medical Group Senior |
$81.27
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
IP
|
$95.61
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cigna of CA HMO |
$66.93
|
| Rate for Payer: Cigna of CA PPO |
$66.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.24
|
| Rate for Payer: EPIC Health Plan Senior |
$38.24
|
| Rate for Payer: Galaxy Health WC |
$81.27
|
| Rate for Payer: Global Benefits Group Commercial |
$57.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.95
|
| Rate for Payer: Multiplan Commercial |
$76.49
|
| Rate for Payer: Networks By Design Commercial |
$62.15
|
| Rate for Payer: Prime Health Services Commercial |
$81.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Other HMO |
$34.93
|
| Rate for Payer: United Healthcare HMO Rider |
$34.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.31
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
OP
|
$107.24
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.91
|
| Rate for Payer: Blue Shield of California Commercial |
$82.47
|
| Rate for Payer: Blue Shield of California Commercial |
$54.37
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cigna of CA HMO |
$75.07
|
| Rate for Payer: Cigna of CA PPO |
$75.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Senior |
$42.90
|
| Rate for Payer: Galaxy Health WC |
$91.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.07
|
| Rate for Payer: Multiplan Commercial |
$85.79
|
| Rate for Payer: Networks By Design Commercial |
$53.62
|
| Rate for Payer: Prime Health Services Commercial |
$91.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.25
|
| Rate for Payer: United Healthcare All Other HMO |
$39.17
|
| Rate for Payer: United Healthcare HMO Rider |
$38.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.15
|
| Rate for Payer: Vantage Medical Group Senior |
$91.15
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
IP
|
$107.24
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cigna of CA HMO |
$75.07
|
| Rate for Payer: Cigna of CA PPO |
$75.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Senior |
$42.90
|
| Rate for Payer: Galaxy Health WC |
$91.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$85.79
|
| Rate for Payer: Networks By Design Commercial |
$69.71
|
| Rate for Payer: Prime Health Services Commercial |
$91.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.25
|
| Rate for Payer: United Healthcare All Other HMO |
$39.17
|
| Rate for Payer: United Healthcare HMO Rider |
$38.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.01
|
| Rate for Payer: Blue Shield of California Commercial |
$77.06
|
| Rate for Payer: Blue Shield of California Commercial |
$116.89
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.01
|
| Rate for Payer: Blue Shield of California Commercial |
$77.06
|
| Rate for Payer: Blue Shield of California Commercial |
$116.89
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
IP
|
$273.84
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Adventist Health Commercial |
$54.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$178.00
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
OP
|
$273.84
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$232.76 |
| Rate for Payer: Adventist Health Commercial |
$112.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.76
|
| Rate for Payer: Blue Shield of California Commercial |
$138.84
|
| Rate for Payer: Blue Shield of California Commercial |
$210.58
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cigna of CA HMO |
$191.69
|
| Rate for Payer: Cigna of CA PPO |
$191.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.54
|
| Rate for Payer: EPIC Health Plan Senior |
$109.54
|
| Rate for Payer: Galaxy Health WC |
$232.76
|
| Rate for Payer: Global Benefits Group Commercial |
$164.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.69
|
| Rate for Payer: Multiplan Commercial |
$219.07
|
| Rate for Payer: Networks By Design Commercial |
$136.92
|
| Rate for Payer: Prime Health Services Commercial |
$232.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.77
|
| Rate for Payer: United Healthcare All Other HMO |
$100.03
|
| Rate for Payer: United Healthcare HMO Rider |
$97.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.76
|
| Rate for Payer: Vantage Medical Group Senior |
$232.76
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
IP
|
$295.33
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.07 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna of CA HMO |
$206.73
|
| Rate for Payer: Cigna of CA PPO |
$206.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.13
|
| Rate for Payer: EPIC Health Plan Senior |
$118.13
|
| Rate for Payer: Galaxy Health WC |
$251.03
|
| Rate for Payer: Global Benefits Group Commercial |
$177.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.88
|
| Rate for Payer: Multiplan Commercial |
$236.26
|
| Rate for Payer: Networks By Design Commercial |
$191.96
|
| Rate for Payer: Prime Health Services Commercial |
$251.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.84
|
| Rate for Payer: United Healthcare All Other HMO |
$107.88
|
| Rate for Payer: United Healthcare HMO Rider |
$105.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.72
|
|
