|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,089.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
OP
|
$6,434.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$156.39 |
| Max. Negotiated Rate |
$7,041.28 |
| Rate for Payer: Adventist Health Commercial |
$1,286.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,220.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,478.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,951.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,937.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,599.34
|
| Rate for Payer: Cash Price |
$2,895.30
|
| Rate for Payer: Cash Price |
$2,895.30
|
| Rate for Payer: Cigna of CA HMO |
$4,117.76
|
| Rate for Payer: Cigna of CA PPO |
$4,761.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,726.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,478.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,345.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2,478.31
|
| Rate for Payer: Galaxy Health WC |
$5,468.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,860.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,064.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,478.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,291.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,478.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,544.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,320.94
|
| Rate for Payer: Multiplan Commercial |
$5,147.20
|
| Rate for Payer: Networks By Design Commercial |
$4,182.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,468.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,860.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,860.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,041.28
|
| Rate for Payer: United Healthcare All Other HMO |
$7,041.28
|
| Rate for Payer: United Healthcare HMO Rider |
$7,041.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,041.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,478.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2,478.31
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
IP
|
$6,434.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,286.80 |
| Max. Negotiated Rate |
$5,468.90 |
| Rate for Payer: Adventist Health Commercial |
$1,286.80
|
| Rate for Payer: Cash Price |
$2,895.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,573.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,573.60
|
| Rate for Payer: Galaxy Health WC |
$5,468.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,860.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,291.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,451.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,544.16
|
| Rate for Payer: Multiplan Commercial |
$5,147.20
|
| Rate for Payer: Networks By Design Commercial |
$4,182.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,468.90
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
IP
|
$2,976.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$2,529.60 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.40
|
| Rate for Payer: Galaxy Health WC |
$2,529.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,984.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,133.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.24
|
| Rate for Payer: Multiplan Commercial |
$2,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,934.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,529.60
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
OP
|
$2,976.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$3,256.45 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,827.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,821.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,202.30
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna of CA HMO |
$1,904.64
|
| Rate for Payer: Cigna of CA PPO |
$2,202.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$2,529.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,785.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$726.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,984.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,934.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,529.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,785.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,785.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,256.45
|
| Rate for Payer: United Healthcare All Other HMO |
$3,256.45
|
| Rate for Payer: United Healthcare HMO Rider |
$3,256.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,089.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,072.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,065.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,363.50
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO |
$2,160.00
|
| Rate for Payer: Cigna of CA PPO |
$2,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,382.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
905352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
905352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.14
|
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$71.44
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.14
|
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$71.44
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.64
|
| Rate for Payer: Blue Shield of California Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California EPN |
$38.90
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$436.69 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.69
|
| Rate for Payer: Blue Shield of California Commercial |
$155.21
|
| Rate for Payer: Blue Shield of California EPN |
$102.54
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$163.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$537.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cigna of CA HMO |
$524.16
|
| Rate for Payer: Cigna of CA PPO |
$606.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.44
|
| Rate for Payer: EPIC Health Plan Senior |
$381.07
|
| Rate for Payer: Galaxy Health WC |
$696.15
|
| Rate for Payer: Global Benefits Group Commercial |
$491.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$480.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.63
|
| Rate for Payer: Multiplan Commercial |
$655.20
|
| Rate for Payer: Networks By Design Commercial |
$532.35
|
| Rate for Payer: Prime Health Services Commercial |
$696.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$491.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$381.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$696.15 |
| Rate for Payer: Adventist Health Commercial |
$163.80
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$327.60
|
| Rate for Payer: Galaxy Health WC |
$696.15
|
| Rate for Payer: Global Benefits Group Commercial |
$491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.56
|
| Rate for Payer: Multiplan Commercial |
$655.20
|
| Rate for Payer: Networks By Design Commercial |
$532.35
|
| Rate for Payer: Prime Health Services Commercial |
$696.15
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
915352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.77
|
| Rate for Payer: Blue Shield of California Commercial |
$398.52
|
| Rate for Payer: Blue Shield of California EPN |
$262.44
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
915352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.77
|
| Rate for Payer: Blue Shield of California Commercial |
$398.52
|
| Rate for Payer: Blue Shield of California EPN |
$262.44
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.22
|
| Rate for Payer: Blue Shield of California Commercial |
$183.76
|
| Rate for Payer: Blue Shield of California EPN |
$121.01
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.22
|
| Rate for Payer: Blue Shield of California Commercial |
$183.76
|
| Rate for Payer: Blue Shield of California EPN |
$121.01
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
