|
HC URINARY DRAIN SET CATH 8FR
|
Facility
|
OP
|
$248.36
|
|
| Hospital Charge Code |
901698512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.67 |
| Max. Negotiated Rate |
$223.52 |
| Rate for Payer: Adventist Health Commercial |
$49.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.47
|
| Rate for Payer: Blue Shield of California Commercial |
$157.46
|
| Rate for Payer: Blue Shield of California EPN |
$99.10
|
| Rate for Payer: Cash Price |
$111.76
|
| Rate for Payer: Central Health Plan Commercial |
$198.69
|
| Rate for Payer: Cigna of CA HMO |
$158.95
|
| Rate for Payer: Cigna of CA PPO |
$183.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.34
|
| Rate for Payer: EPIC Health Plan Senior |
$99.34
|
| Rate for Payer: Galaxy Health WC |
$211.11
|
| Rate for Payer: Global Benefits Group Commercial |
$149.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$173.85
|
| Rate for Payer: Multiplan Commercial |
$186.27
|
| Rate for Payer: Networks By Design Commercial |
$161.43
|
| Rate for Payer: Prime Health Services Commercial |
$211.11
|
| Rate for Payer: Riverside University Health System MISP |
$99.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.18
|
| Rate for Payer: United Healthcare All Other HMO |
$124.18
|
| Rate for Payer: United Healthcare HMO Rider |
$124.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.11
|
| Rate for Payer: Vantage Medical Group Senior |
$211.11
|
|
|
HC URINARY DRAIN SET CATH 8FR
|
Facility
|
IP
|
$248.36
|
|
| Hospital Charge Code |
901698512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.67 |
| Max. Negotiated Rate |
$223.52 |
| Rate for Payer: Adventist Health Commercial |
$49.67
|
| Rate for Payer: Cash Price |
$111.76
|
| Rate for Payer: Central Health Plan Commercial |
$198.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.34
|
| Rate for Payer: EPIC Health Plan Senior |
$99.34
|
| Rate for Payer: Galaxy Health WC |
$211.11
|
| Rate for Payer: Global Benefits Group Commercial |
$149.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.67
|
| Rate for Payer: Multiplan Commercial |
$186.27
|
| Rate for Payer: Networks By Design Commercial |
$161.43
|
| Rate for Payer: Prime Health Services Commercial |
$211.11
|
|
|
HC URINE CHEMISTRY SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.74
|
| Rate for Payer: Blue Shield of California Commercial |
$54.81
|
| Rate for Payer: Blue Shield of California EPN |
$34.54
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Senior |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.25
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Medicare |
$2.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE CHEMISTRY SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.74
|
| Rate for Payer: Blue Shield of California Commercial |
$54.81
|
| Rate for Payer: Blue Shield of California EPN |
$34.54
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Senior |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.25
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Medicare |
$2.38
|
| Rate for Payer: Riverside University Health System MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC URINE COLL KIT W/5FR CATH
|
Facility
|
OP
|
$219.73
|
|
| Hospital Charge Code |
901698695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Adventist Health Commercial |
$43.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.82
|
| Rate for Payer: Blue Shield of California Commercial |
$139.31
|
| Rate for Payer: Blue Shield of California EPN |
$87.67
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Central Health Plan Commercial |
$175.78
|
| Rate for Payer: Cigna of CA HMO |
$140.63
|
| Rate for Payer: Cigna of CA PPO |
$162.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.89
|
| Rate for Payer: EPIC Health Plan Senior |
$87.89
|
| Rate for Payer: Galaxy Health WC |
$186.77
|
| Rate for Payer: Global Benefits Group Commercial |
$131.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Networks By Design Commercial |
$142.82
|
| Rate for Payer: Prime Health Services Commercial |
$186.77
|
| Rate for Payer: Riverside University Health System MISP |
$87.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.86
|
| Rate for Payer: United Healthcare All Other HMO |
$109.86
|
| Rate for Payer: United Healthcare HMO Rider |
$109.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.77
|
| Rate for Payer: Vantage Medical Group Senior |
$186.77
|
|
|
HC URINE COLL KIT W/5FR CATH
|
Facility
|
IP
|
$219.73
|
|
| Hospital Charge Code |
901698695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Adventist Health Commercial |
$43.95
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Central Health Plan Commercial |
$175.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.89
|
| Rate for Payer: EPIC Health Plan Senior |
$87.89
|
| Rate for Payer: Galaxy Health WC |
$186.77
|
| Rate for Payer: Global Benefits Group Commercial |
$131.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.95
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Networks By Design Commercial |
$142.82
|
| Rate for Payer: Prime Health Services Commercial |
$186.77
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$1,118.97 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.97
|
| Rate for Payer: Blue Shield of California Commercial |
$625.59
|
| Rate for Payer: Blue Shield of California EPN |
$394.22
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: Cigna of CA HMO |
$635.52
|
| Rate for Payer: Cigna of CA PPO |
$734.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$695.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$893.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$630.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$595.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$893.70 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$695.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$397.20
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$893.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$630.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$585.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
|
|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$784.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$514.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.11
|
| 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 |
$368.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.24
|
| Rate for Payer: Blue Shield of California Commercial |
$549.36
|
| Rate for Payer: Blue Shield of California EPN |
$346.18
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| 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 |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$784.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| 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 |
$523.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$523.20
|
| 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: 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 US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.99
|
| Rate for Payer: Blue Shield of California Commercial |
$262.08
|
| Rate for Payer: Blue Shield of California EPN |
$165.15
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$266.24
|
| Rate for Payer: Cigna of CA PPO |
$307.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Riverside University Health System MISP |
$166.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| 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 |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$213.75
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$332.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.00
|
| Rate for Payer: EPIC Health Plan Senior |
$190.00
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$301.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$527.87 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$408.45
|
| 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 |
$527.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.31
|
| Rate for Payer: Blue Shield of California Commercial |
$299.25
|
| Rate for Payer: Blue Shield of California EPN |
$188.57
|
| Rate for Payer: Cash Price |
$213.75
|
| Rate for Payer: Cash Price |
$213.75
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: Cigna of CA HMO |
$304.00
|
| Rate for Payer: Cigna of CA PPO |
$351.50
|
| 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 |
$332.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$301.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
| 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 |
$285.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.48
|
| Rate for Payer: United Healthcare All Other HMO |
$288.48
|
| Rate for Payer: United Healthcare HMO Rider |
$288.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.48
|
| 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 US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$193.60 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Central Health Plan Commercial |
$774.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.20
|
| Rate for Payer: EPIC Health Plan Senior |
$387.20
|
| Rate for Payer: Galaxy Health WC |
$822.80
|
| Rate for Payer: Global Benefits Group Commercial |
$580.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$871.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$571.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.60
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
| Rate for Payer: Networks By Design Commercial |
$629.20
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.81
|
| 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 |
$532.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$563.09
|
| Rate for Payer: Blue Shield of California Commercial |
$609.84
|
| Rate for Payer: Blue Shield of California EPN |
$384.30
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Central Health Plan Commercial |
$774.40
|
| Rate for Payer: Cigna of CA HMO |
$619.52
|
| Rate for Payer: Cigna of CA PPO |
$716.32
|
| 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 |
$677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$822.80
|
| Rate for Payer: Global Benefits Group Commercial |
$580.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$871.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
| Rate for Payer: Networks By Design Commercial |
$629.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
| 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 |
$580.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$580.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.03
|
| Rate for Payer: United Healthcare All Other HMO |
$288.03
|
| Rate for Payer: United Healthcare HMO Rider |
$288.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.03
|
| 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 US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$193.60 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Central Health Plan Commercial |
$774.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.20
|
| Rate for Payer: EPIC Health Plan Senior |
$387.20
|
| Rate for Payer: Galaxy Health WC |
$822.80
|
| Rate for Payer: Global Benefits Group Commercial |
$580.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$871.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$571.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.60
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
| Rate for Payer: Networks By Design Commercial |
$629.20
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$483.55
|
| 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 |
$623.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$563.09
|
| Rate for Payer: Blue Shield of California Commercial |
$609.84
|
| Rate for Payer: Blue Shield of California EPN |
$384.30
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Central Health Plan Commercial |
$774.40
|
| Rate for Payer: Cigna of CA HMO |
$619.52
|
| Rate for Payer: Cigna of CA PPO |
$716.32
|
| 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 |
$677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$822.80
|
| Rate for Payer: Global Benefits Group Commercial |
$580.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$871.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
| Rate for Payer: Networks By Design Commercial |
$629.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
| 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 |
$580.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$580.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.03
|
| Rate for Payer: United Healthcare All Other HMO |
$288.03
|
| Rate for Payer: United Healthcare HMO Rider |
$288.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.03
|
| 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 US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$271.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.54
|
| Rate for Payer: Blue Shield of California Commercial |
$304.92
|
| Rate for Payer: Blue Shield of California EPN |
$192.15
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Central Health Plan Commercial |
$387.20
|
| Rate for Payer: Cigna of CA HMO |
$309.76
|
| Rate for Payer: Cigna of CA PPO |
$358.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$411.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$411.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$411.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$435.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$338.80
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
| Rate for Payer: Riverside University Health System MISP |
$193.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$290.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$290.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$242.00
|
| Rate for Payer: United Healthcare HMO Rider |
$242.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$242.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$411.40
|
| Rate for Payer: Vantage Medical Group Senior |
$411.40
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Central Health Plan Commercial |
$387.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$435.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.80
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
915355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$935.67 |
| Max. Negotiated Rate |
$2,571.30 |
| Rate for Payer: Adventist Health Commercial |
$1,171.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,661.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,291.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,439.93
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,285.60
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,428.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,428.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,571.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,965.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,999.90
|
| Rate for Payer: Multiplan Commercial |
$2,142.75
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,428.45
|
|
