|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$148.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$271.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.58
|
| Rate for Payer: Blue Shield of California Commercial |
$290.32
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$307.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$307.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$253.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Riverside University Health System MISP |
$144.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$307.70
|
| Rate for Payer: Vantage Medical Group Senior |
$307.70
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Blue Shield of California Commercial |
$290.32
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
915356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.79
|
| Rate for Payer: Blue Shield of California Commercial |
$61.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Riverside University Health System MISP |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.79
|
| Rate for Payer: Blue Shield of California Commercial |
$61.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Riverside University Health System MISP |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Blue Shield of California Commercial |
$61.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
915356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Blue Shield of California Commercial |
$61.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
915356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Blue Shield of California Commercial |
$392.98
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Blue Shield of California Commercial |
$392.98
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.47 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.03
|
| Rate for Payer: Blue Shield of California Commercial |
$392.98
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Riverside University Health System MISP |
$196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
915356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.47 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.03
|
| Rate for Payer: Blue Shield of California Commercial |
$392.98
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Riverside University Health System MISP |
$196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Adventist Health Commercial |
$256.40
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$897.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Senior |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$814.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$756.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Adventist Health Commercial |
$256.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,089.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$705.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$961.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$745.11
|
| Rate for Payer: Blue Shield of California Commercial |
$807.66
|
| Rate for Payer: Blue Shield of California EPN |
$508.95
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA HMO |
$820.48
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,089.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,089.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$897.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Senior |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$814.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$756.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Riverside University Health System MISP |
$512.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.00
|
| Rate for Payer: United Healthcare All Other HMO |
$641.00
|
| Rate for Payer: United Healthcare HMO Rider |
$641.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,089.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,089.70
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$561.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$351.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.29
|
| Rate for Payer: Blue Shield of California Commercial |
$582.12
|
| Rate for Payer: Blue Shield of California EPN |
$366.83
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Cigna of CA HMO |
$591.36
|
| Rate for Payer: Cigna of CA PPO |
$683.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$785.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$785.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$646.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$586.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$335.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$646.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
| Rate for Payer: Riverside University Health System MISP |
$369.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$554.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.00
|
| Rate for Payer: United Healthcare All Other HMO |
$462.00
|
| Rate for Payer: United Healthcare HMO Rider |
$462.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Vantage Medical Group Senior |
$785.40
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$646.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$586.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$550.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.54
|
| Rate for Payer: Blue Shield of California Commercial |
$627.48
|
| Rate for Payer: Blue Shield of California EPN |
$395.41
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$587.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$826.01
|
| Rate for Payer: Blue Shield of California Commercial |
$894.60
|
| Rate for Payer: Blue Shield of California EPN |
$563.74
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Riverside University Health System MISP |
$568.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.60 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,506.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,318.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$753.20
|
| Rate for Payer: EPIC Health Plan Senior |
$753.20
|
| Rate for Payer: Galaxy Health WC |
$1,600.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,129.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,694.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,195.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,110.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.60
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: Networks By Design Commercial |
$1,223.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,600.55
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,095.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,186.29
|
| Rate for Payer: Blue Shield of California EPN |
$747.55
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,506.40
|
| Rate for Payer: Cigna of CA HMO |
$1,205.12
|
| Rate for Payer: Cigna of CA PPO |
$1,393.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,318.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,600.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,129.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,694.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,195.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: Networks By Design Commercial |
$1,223.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,600.55
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,129.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,129.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,621.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$200.47 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,511.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,061.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$472.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,598.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,731.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,090.96
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Cigna of CA HMO |
$1,758.72
|
| Rate for Payer: Cigna of CA PPO |
$2,033.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,335.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,335.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,621.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,923.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,099.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,648.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.47 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,511.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,061.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$472.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,598.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,731.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,090.96
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Cigna of CA HMO |
$1,758.72
|
| Rate for Payer: Cigna of CA PPO |
$2,033.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,335.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,335.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,621.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,923.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,099.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,648.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,374.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,374.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,621.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
