|
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 |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| 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 |
$368.46
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: Cash Price |
$258.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$364.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.78
|
| 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 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 |
$49.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| 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
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| 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 Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.09
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.89
|
| Rate for Payer: EPIC Health Plan Senior |
$15.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15.93
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| 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 All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| 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 Commercial/Exchange |
$21.72
|
|
|
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 |
$112.09 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| 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 Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.09
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.89
|
| Rate for Payer: EPIC Health Plan Senior |
$15.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15.93
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| 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 All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| 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 Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
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 |
$49.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| 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 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 |
$1,146.44
|
| Rate for Payer: Blue Shield of California Commercial |
$960.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,456.49
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| 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 |
$1,231.10
|
| 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 |
$1,146.44
|
| Rate for Payer: Blue Shield of California Commercial |
$960.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,456.49
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| 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 |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| 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 |
$1,231.10
|
| 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 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 |
$941.24
|
| Rate for Payer: Blue Shield of California Commercial |
$788.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.80
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$674.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$987.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$917.45
|
| 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 |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$987.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$917.45
|
| 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 |
$1,010.75
|
| 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 |
$941.24
|
| Rate for Payer: Blue Shield of California Commercial |
$788.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.80
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$674.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$987.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$917.45
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$987.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$917.45
|
| 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 |
$1,010.75
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| 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 |
$16.25
|
| 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 |
$15.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$11.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| 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 |
$286.45
|
| Rate for Payer: Blue Shield of California Commercial |
$434.49
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$395.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| 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 |
$1,170.33 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.80
|
| Rate for Payer: Blue Shield of California Commercial |
$237.87
|
| Rate for Payer: Blue Shield of California Commercial |
$360.47
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| 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 |
$226.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.56
|
| Rate for Payer: EPIC Health Plan Senior |
$199.71
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$181.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$243.28
|
| 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 |
$181.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Vantage Medical Group Senior |
$199.71
|
|
|
HC RADIAL ARTERY CATH KIT 20G 4FR
|
Facility
|
OP
|
$183.89
|
|
| Hospital Charge Code |
901698976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$156.31 |
| Rate for Payer: EPIC Health Plan Commercial |
$73.56
|
| Rate for Payer: EPIC Health Plan Senior |
$73.56
|
| Rate for Payer: Galaxy Health WC |
$156.31
|
| Rate for Payer: Adventist Health Commercial |
$36.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.00
|
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Cigna of CA HMO |
$117.69
|
| Rate for Payer: Cigna of CA PPO |
$136.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.72
|
| Rate for Payer: Global Benefits Group Commercial |
$110.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.72
|
| Rate for Payer: Multiplan Commercial |
$147.11
|
| Rate for Payer: Networks By Design Commercial |
$119.53
|
| Rate for Payer: Prime Health Services Commercial |
$156.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.94
|
| Rate for Payer: United Healthcare All Other HMO |
$91.94
|
| Rate for Payer: United Healthcare HMO Rider |
$91.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.31
|
| Rate for Payer: Vantage Medical Group Senior |
$156.31
|
|
|
HC RADIAL ARTERY CATH KIT 20G 4FR
|
Facility
|
IP
|
$183.89
|
|
| Hospital Charge Code |
901698976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$156.31 |
| Rate for Payer: Adventist Health Commercial |
$36.78
|
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.56
|
| Rate for Payer: EPIC Health Plan Senior |
$73.56
|
| Rate for Payer: Galaxy Health WC |
$156.31
|
| Rate for Payer: Global Benefits Group Commercial |
$110.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.13
|
| Rate for Payer: Multiplan Commercial |
$147.11
|
| Rate for Payer: Networks By Design Commercial |
$119.53
|
| Rate for Payer: Prime Health Services Commercial |
$156.31
|
|
|
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 |
$81.72
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$68.44
|
| Rate for Payer: Cash Price |
$60.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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 |
$87.75
|
| 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 |
$14,109.00 |
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| 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
|
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 |
$81.72
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$68.44
|
| Rate for Payer: Cash Price |
$60.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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 RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| 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
|
|
|
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 |
$1,841.01 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,841.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$744.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$545.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.88
|
| Rate for Payer: Blue Shield of California Commercial |
$506.57
|
| Rate for Payer: Blue Shield of California Commercial |
$334.27
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| 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 |
$744.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.52
|
| Rate for Payer: EPIC Health Plan Senior |
$545.68
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$813.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$496.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$694.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$625.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$664.73
|
| 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 |
$496.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$744.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.68
|
| Rate for Payer: Vantage Medical Group Senior |
$496.07
|
|
