|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
OP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Adventist Health Commercial |
$83.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.45
|
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: Cigna of CA HMO |
$267.26
|
| Rate for Payer: Cigna of CA PPO |
$309.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$354.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Senior |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.32
|
| Rate for Payer: Multiplan Commercial |
$334.08
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.80
|
| Rate for Payer: United Healthcare All Other HMO |
$208.80
|
| Rate for Payer: United Healthcare HMO Rider |
$208.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.96
|
| Rate for Payer: Vantage Medical Group Senior |
$354.96
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$354.96 |
| Rate for Payer: Adventist Health Commercial |
$83.52
|
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Senior |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.22
|
| Rate for Payer: Multiplan Commercial |
$334.08
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
OP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.62
|
| Rate for Payer: Cash Price |
$315.81
|
| Rate for Payer: Cigna of CA HMO |
$367.49
|
| Rate for Payer: Cigna of CA PPO |
$424.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$488.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$488.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.94
|
| Rate for Payer: Multiplan Commercial |
$459.36
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO |
$287.10
|
| Rate for Payer: United Healthcare HMO Rider |
$287.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$488.07
|
| Rate for Payer: Vantage Medical Group Senior |
$488.07
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
IP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$315.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.81
|
| Rate for Payer: Multiplan Commercial |
$459.36
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.26
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC PYRUVATE CSF
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC PYRUVATE CSF
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.26
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$1,321.75 |
| Rate for Payer: Adventist Health Commercial |
$637.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$900.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.59
|
| Rate for Payer: Blue Shield of California EPN |
$755.73
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$674.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
915352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
915352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$1,321.75 |
| Rate for Payer: Adventist Health Commercial |
$637.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$900.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.59
|
| Rate for Payer: Blue Shield of California EPN |
$755.73
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$674.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
|
HC QUANTITATIVE GAIT ANALYSIS W/R
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
905370011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC QUANTITATIVE GAIT ANALYSIS W/R
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
905370011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Blue Shield of California Commercial |
$416.97
|
| Rate for Payer: Blue Shield of California EPN |
$274.59
|
| Rate for Payer: Cash Price |
$310.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.04
|
| Rate for Payer: United Healthcare All Other HMO |
$206.39
|
| Rate for Payer: United Healthcare HMO Rider |
$201.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.04
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.97
|
| Rate for Payer: Blue Shield of California Commercial |
$345.78
|
| Rate for Payer: Blue Shield of California EPN |
$228.26
|
| Rate for Payer: Cash Price |
$310.75
|
| Rate for Payer: Cash Price |
$310.75
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.90
|
| Rate for Payer: EPIC Health Plan Senior |
$171.78
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$216.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.19
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.04
|
| Rate for Payer: United Healthcare All Other HMO |
$206.39
|
| Rate for Payer: United Healthcare HMO Rider |
$201.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Vantage Medical Group Senior |
$188.96
|
|
|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.19
|
| Rate for Payer: Blue Shield of California Commercial |
$99.63
|
| Rate for Payer: Blue Shield of California EPN |
$65.61
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.19
|
| Rate for Payer: Blue Shield of California Commercial |
$99.63
|
| Rate for Payer: Blue Shield of California EPN |
$65.61
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.14
|
| Rate for Payer: Blue Shield of California Commercial |
$485.93
|
| Rate for Payer: Blue Shield of California EPN |
$320.78
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.09
|
| Rate for Payer: EPIC Health Plan Senior |
$334.14
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$334.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$421.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$447.75
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$334.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Vantage Medical Group Senior |
$334.14
|
|
