|
HC THYROID SCAN
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$230.20 |
| Max. Negotiated Rate |
$1,035.90 |
| Rate for Payer: Adventist Health Commercial |
$230.20
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Central Health Plan Commercial |
$920.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$460.40
|
| Rate for Payer: Galaxy Health WC |
$978.35
|
| Rate for Payer: Global Benefits Group Commercial |
$690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$679.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.20
|
| Rate for Payer: Multiplan Commercial |
$863.25
|
| Rate for Payer: Networks By Design Commercial |
$748.15
|
| Rate for Payer: Prime Health Services Commercial |
$978.35
|
|
|
HC THYROID UPTAKE MULT
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$692.10 |
| Rate for Payer: Adventist Health Commercial |
$153.80
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Central Health Plan Commercial |
$615.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$538.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.80
|
| Rate for Payer: Multiplan Commercial |
$576.75
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
|
|
HC THYROID UPTAKE MULT
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.80 |
| Max. Negotiated Rate |
$848.38 |
| Rate for Payer: Adventist Health Commercial |
$153.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$443.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.33
|
| Rate for Payer: Blue Shield of California Commercial |
$484.47
|
| Rate for Payer: Blue Shield of California EPN |
$305.29
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Central Health Plan Commercial |
$615.20
|
| Rate for Payer: Cigna of CA HMO |
$492.16
|
| Rate for Payer: Cigna of CA PPO |
$569.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$538.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$576.75
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.92
|
| Rate for Payer: United Healthcare All Other HMO |
$291.92
|
| Rate for Payer: United Healthcare HMO Rider |
$291.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,961.10 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,743.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,525.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,961.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.80
|
| Rate for Payer: Multiplan Commercial |
$1,634.25
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$367.22 |
| Max. Negotiated Rate |
$1,961.10 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,313.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,316.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,267.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.77
|
| Rate for Payer: Blue Shield of California EPN |
$865.06
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,743.20
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,525.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,961.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$367.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,383.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,634.25
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$596.32
|
| Rate for Payer: United Healthcare All Other HMO |
$596.32
|
| Rate for Payer: United Healthcare HMO Rider |
$596.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC THYROXIN T4
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC THYROXIN T4
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.39
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.74
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.34
|
| Rate for Payer: EPIC Health Plan Senior |
$7.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.56
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.87
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Prime Health Services Medicare |
$7.28
|
| Rate for Payer: Prime Health Services Medicare |
$7.28
|
| Rate for Payer: Riverside University Health System MISP |
$7.56
|
| Rate for Payer: Riverside University Health System MISP |
$7.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO |
$5.56
|
| Rate for Payer: United Healthcare HMO Rider |
$5.56
|
| Rate for Payer: United Healthcare HMO Rider |
$5.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
|
|
HC TIBIA FIBULA
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.60 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Central Health Plan Commercial |
$810.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$709.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Senior |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.60
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC TIBIA FIBULA
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.02
|
| Rate for Payer: Blue Shield of California Commercial |
$638.19
|
| Rate for Payer: Blue Shield of California EPN |
$402.16
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Central Health Plan Commercial |
$810.40
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$709.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
915352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.02
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
905352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.02
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
915352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.20
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.02
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Riverside University Health System MISP |
$52.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
905352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.20
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.02
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Riverside University Health System MISP |
$52.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC TIG HUMAN INTRAMUSCULAR USE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 90389
|
| Hospital Charge Code |
902890180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC TIG HUMAN INTRAMUSCULAR USE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 90389
|
| Hospital Charge Code |
902890180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$4,062.75 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,062.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.94
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$135.68
|
| Rate for Payer: Cigna of CA PPO |
$156.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC TILT TABLE TEST
|
Facility
|
OP
|
$4,553.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
900200144
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$428.33 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$910.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$428.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,204.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,648.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,642.40
|
| Rate for Payer: Cigna of CA HMO |
$2,913.92
|
| Rate for Payer: Cigna of CA PPO |
$3,369.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,187.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$3,870.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,731.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,097.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,891.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$3,414.75
|
| Rate for Payer: Networks By Design Commercial |
$2,959.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$3,870.05
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,731.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,731.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC TILT TABLE TEST
|
Facility
|
IP
|
$4,553.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
900200144
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$910.60 |
| Max. Negotiated Rate |
$4,097.70 |
| Rate for Payer: Adventist Health Commercial |
$910.60
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,642.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,187.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,821.20
|
| Rate for Payer: Galaxy Health WC |
$3,870.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,731.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,097.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,891.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,686.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.60
|
| Rate for Payer: Multiplan Commercial |
$3,414.75
|
| Rate for Payer: Networks By Design Commercial |
$2,959.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,870.05
|
|
|
HC TIP ARGYLE YANKAUER SUCTN 12FR
|
Facility
|
OP
|
$4.35
|
|
| Hospital Charge Code |
901698614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC TIP ARGYLE YANKAUER SUCTN 12FR
|
Facility
|
IP
|
$4.35
|
|
| Hospital Charge Code |
901698614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.18
|
| Rate for Payer: Blue Shield of California Commercial |
$125.53
|
| Rate for Payer: Blue Shield of California EPN |
$79.00
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$126.72
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Riverside University Health System MISP |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC TIPS CATHETER SET
|
Facility
|
IP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$955.80 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Central Health Plan Commercial |
$849.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$743.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Senior |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$955.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$674.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$626.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.40
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
|
|
HC TIPS CATHETER SET
|
Facility
|
OP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$955.80 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$796.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$514.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.77
|
| Rate for Payer: Blue Shield of California Commercial |
$673.31
|
| Rate for Payer: Blue Shield of California EPN |
$423.74
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Central Health Plan Commercial |
$849.60
|
| Rate for Payer: Cigna of CA HMO |
$679.68
|
| Rate for Payer: Cigna of CA PPO |
$785.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$902.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$902.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$902.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$743.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Senior |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$955.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$674.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$626.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
| Rate for Payer: Riverside University Health System MISP |
$424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$531.00
|
| Rate for Payer: United Healthcare All Other HMO |
$531.00
|
| Rate for Payer: United Healthcare HMO Rider |
$531.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$531.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$902.70
|
| Rate for Payer: Vantage Medical Group Senior |
$902.70
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
IP
|
$12,014.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,402.80 |
| Max. Negotiated Rate |
$10,812.60 |
| Rate for Payer: Adventist Health Commercial |
$2,402.80
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,611.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,409.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,805.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,805.60
|
| Rate for Payer: Galaxy Health WC |
$10,211.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,208.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,812.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,628.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,088.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,402.80
|
| Rate for Payer: Multiplan Commercial |
$9,010.50
|
| Rate for Payer: Networks By Design Commercial |
$7,809.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,211.90
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
OP
|
$12,014.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.62 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$2,402.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,611.20
|
| Rate for Payer: Cigna of CA HMO |
$7,688.96
|
| Rate for Payer: Cigna of CA PPO |
$8,890.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,409.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$10,211.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,208.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,812.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,628.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,402.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$9,010.50
|
| Rate for Payer: Networks By Design Commercial |
$7,809.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,211.90
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,208.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,007.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
