|
HC LMA FASTRACH CHILD #4
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.12
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cigna of CA HMO |
$210.56
|
| Rate for Payer: Cigna of CA PPO |
$243.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$279.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$279.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$279.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$230.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$230.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.30
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.50
|
| Rate for Payer: United Healthcare All Other HMO |
$164.50
|
| Rate for Payer: United Healthcare HMO Rider |
$164.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$279.65
|
| Rate for Payer: Vantage Medical Group Senior |
$279.65
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$230.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$850.85 |
| Rate for Payer: Adventist Health Commercial |
$200.20
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$800.80
|
| Rate for Payer: Networks By Design Commercial |
$650.65
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$1,537.76 |
| Rate for Payer: Adventist Health Commercial |
$200.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,537.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$642.34
|
| Rate for Payer: Blue Shield of California Commercial |
$638.64
|
| Rate for Payer: Blue Shield of California Commercial |
$421.42
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cigna of CA HMO |
$640.64
|
| Rate for Payer: Cigna of CA PPO |
$740.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$800.80
|
| Rate for Payer: Networks By Design Commercial |
$650.65
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
915356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,439.52 |
| Max. Negotiated Rate |
$5,098.30 |
| Rate for Payer: Adventist Health Commercial |
$2,459.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,498.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,630.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,612.46
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.99
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,098.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,098.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,180.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,465.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,198.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,198.60
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Networks By Design Commercial |
$2,999.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
905356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
905356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,439.52 |
| Max. Negotiated Rate |
$5,098.30 |
| Rate for Payer: Adventist Health Commercial |
$2,459.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,498.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,630.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,612.46
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.99
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,098.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,098.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,180.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,465.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,198.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,198.60
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Networks By Design Commercial |
$2,999.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
915356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$2.75
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.01
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.15
|
| Rate for Payer: United Healthcare HMO Rider |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3.65
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.44
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
|
IP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Senior |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
|
OP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$6.02
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Senior |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Vantage Medical Group Senior |
$7.99
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 240
|
Facility
|
OP
|
$2.95
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
909081005
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.51
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 240
|
Facility
|
IP
|
$2.95
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
909081005
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.51
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 300
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081006
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 300
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081006
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$3.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$2.73
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.13
|
| Rate for Payer: United Healthcare All Other HMO |
$2.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Vantage Medical Group Senior |
$3.63
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.74
|
| Rate for Payer: Blue Shield of California Commercial |
$70.98
|
| Rate for Payer: Blue Shield of California Commercial |
$107.66
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
915350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.74
|
| Rate for Payer: Blue Shield of California Commercial |
$70.98
|
| Rate for Payer: Blue Shield of California Commercial |
$107.66
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
915350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.54
|
| Rate for Payer: United Healthcare All Other HMO |
$51.14
|
| Rate for Payer: United Healthcare HMO Rider |
$50.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.85
|
|
