|
HC URINARY DRAIN SET CATH 8FR
|
Facility
IP
|
$220.22
|
|
| Hospital Charge Code |
901698512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$198.20 |
| Rate for Payer: Cash Price |
$99.10
|
| Rate for Payer: Central Health Plan Commercial |
$176.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.09
|
| Rate for Payer: Galaxy Health WC |
$187.19
|
| Rate for Payer: Global Benefits Group Commercial |
$132.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.04
|
| Rate for Payer: Multiplan Commercial |
$165.16
|
| Rate for Payer: Networks By Design Commercial |
$143.14
|
| Rate for Payer: Prime Health Services Commercial |
$187.19
|
|
|
HC URINE CHEMISTRY SCREEN
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC URINE CHEMISTRY SCREEN
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: AlphaCare 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 |
$19.95
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Caremore Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.69
|
| Rate for Payer: IEHP medi-cal |
$3.71
|
| Rate for Payer: IEHP Medicare Advantage |
$2.25
|
| Rate for Payer: Innovage PACE Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$2.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: Riverside University Health MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| 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: 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
OP
|
$89.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: AlphaCare 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 |
$19.95
|
| Rate for Payer: BCBS Transplant Transplant |
$53.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.00
|
| Rate for Payer: Blue Shield of California EPN |
$43.25
|
| Rate for Payer: Caremore Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.69
|
| Rate for Payer: IEHP medi-cal |
$3.71
|
| Rate for Payer: IEHP Medicare Advantage |
$2.25
|
| Rate for Payer: Innovage PACE Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Prime Health Services Medicare |
$2.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: Riverside University Health MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| 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: 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
|
$89.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC URINE COLL KIT W/5FR CATH
|
Facility
OP
|
$197.05
|
|
| Hospital Charge Code |
901698695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$167.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$108.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$108.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.42
|
| Rate for Payer: BCBS Transplant Transplant |
$118.23
|
| Rate for Payer: Blue Shield of California Commercial |
$123.94
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$88.67
|
| Rate for Payer: Central Health Plan Commercial |
$157.64
|
| Rate for Payer: Cigna of CA HMO |
$126.11
|
| Rate for Payer: Cigna of CA PPO |
$145.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$78.82
|
| Rate for Payer: Galaxy Health WC |
$167.49
|
| Rate for Payer: Global Benefits Group Commercial |
$118.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$147.79
|
| Rate for Payer: IEHP medi-cal |
$68.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.41
|
| Rate for Payer: Multiplan Commercial |
$147.79
|
| Rate for Payer: Networks By Design Commercial |
$128.08
|
| Rate for Payer: Prime Health Services Commercial |
$167.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$118.23
|
| Rate for Payer: Riverside University Health MISP |
$78.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.52
|
| Rate for Payer: United Healthcare All Other HMO |
$98.52
|
| Rate for Payer: United Healthcare HMO Rider |
$98.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.49
|
| Rate for Payer: Vantage Medical Group Senior |
$167.49
|
|
|
HC URINE COLL KIT W/5FR CATH
|
Facility
IP
|
$197.05
|
|
| Hospital Charge Code |
901698695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Cash Price |
$88.67
|
| Rate for Payer: Central Health Plan Commercial |
$157.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.82
|
| Rate for Payer: Galaxy Health WC |
$167.49
|
| Rate for Payer: Global Benefits Group Commercial |
$118.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.41
|
| Rate for Payer: Multiplan Commercial |
$147.79
|
| Rate for Payer: Networks By Design Commercial |
$128.08
|
| Rate for Payer: Prime Health Services Commercial |
$167.49
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
OP
|
$993.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$988.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.99
|
| Rate for Payer: BCBS Transplant Transplant |
$595.80
|
| Rate for Payer: Blue Shield of California Commercial |
$613.67
|
| Rate for Payer: Blue Shield of California EPN |
$482.60
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| 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 |
$720.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$744.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: IEHP medi-cal |
$792.82
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Innovage PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$595.80
|
| Rate for Payer: Riverside University Health MISP |
$528.55
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
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: Cash Price |
$446.85
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$662.33
|
| 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
OP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| 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: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1.48
|
| Rate for Payer: IEHP medi-cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
IP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.31
|
| 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 US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
IP
|
$776.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
OP
|
$776.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$368.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$458.46
|
| Rate for Payer: BCBS Transplant Transplant |
$465.60
|
| Rate for Payer: Blue Shield of California Commercial |
$479.57
|
| Rate for Payer: Blue Shield of California EPN |
$377.14
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$496.64
|
| Rate for Payer: Cigna of CA PPO |
$574.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$582.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| 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 |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
OP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$182.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$203.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.60
|
| Rate for Payer: BCBS Transplant Transplant |
$222.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.66
|
| Rate for Payer: Blue Shield of California EPN |
$179.82
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$236.80
|
| Rate for Payer: Cigna of CA PPO |
$273.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$277.50
|
| Rate for Payer: IEHP medi-cal |
$129.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: Riverside University Health MISP |
$148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| 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 |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
IP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
OP
|
$411.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$28,848.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$527.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.82
|
| Rate for Payer: BCBS Transplant Transplant |
$246.60
|
| Rate for Payer: Blue Shield of California Commercial |
$254.00
|
| Rate for Payer: Blue Shield of California EPN |
$199.75
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$246.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| 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 |
$28,848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
IP
|
$411.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$28,803.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.68
|
| Rate for Payer: BCBS Transplant Transplant |
$516.60
|
| Rate for Payer: Blue Shield of California Commercial |
$532.10
|
| Rate for Payer: Blue Shield of California EPN |
$418.45
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Central Health Plan Commercial |
$688.80
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$774.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$645.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| 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 |
$28,803.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$774.90 |
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Central Health Plan Commercial |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$774.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
IP
|
$861.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$774.90 |
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Central Health Plan Commercial |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$774.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
OP
|
$861.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$28,803.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$441.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$623.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.68
|
| Rate for Payer: BCBS Transplant Transplant |
$516.60
|
| Rate for Payer: Blue Shield of California Commercial |
$532.10
|
| Rate for Payer: Blue Shield of California EPN |
$418.45
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Central Health Plan Commercial |
$688.80
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$774.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$645.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| 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 |
$28,803.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$366.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$237.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$237.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$271.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.63
|
| Rate for Payer: BCBS Transplant Transplant |
$258.60
|
| Rate for Payer: Blue Shield of California Commercial |
$266.36
|
| Rate for Payer: Blue Shield of California EPN |
$209.47
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$323.25
|
| Rate for Payer: IEHP medi-cal |
$150.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: Riverside University Health MISP |
$172.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.50
|
| Rate for Payer: United Healthcare All Other HMO |
$215.50
|
| Rate for Payer: United Healthcare HMO Rider |
$215.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.35
|
| Rate for Payer: Vantage Medical Group Senior |
$366.35
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
OP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
905355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$999.95 |
| Max. Negotiated Rate |
$7,209.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,209.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,571.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,571.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,383.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,687.92
|
| Rate for Payer: BCBS Transplant Transplant |
$1,714.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,142.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,554.21
|
| 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: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,142.75
|
| Rate for Payer: IEHP medi-cal |
$999.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.37
|
| 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 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 |
$1,428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,428.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,428.45
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
IP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
905355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$2,571.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,525.64
|
| 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: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.40
|
| 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
|
|
