|
HC UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$893.70 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.74
|
| Rate for Payer: Blue Shield of California Commercial |
$602.75
|
| Rate for Payer: Blue Shield of California EPN |
$394.22
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: Cash Price |
$546.15
|
| 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 |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| 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 |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| 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 |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| 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 |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
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 |
$1.77 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.20
|
| 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 |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$1.08
|
| 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: 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: InnovAge PACE Commercial |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.38
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| 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 Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| 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
|
$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 |
$479.60
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| 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 Permanente of CA Commercial/Self Funded |
$581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$539.77
|
| 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 |
$135.12 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$529.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$368.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.13
|
| Rate for Payer: Blue Shield of California Commercial |
$529.30
|
| Rate for Payer: Blue Shield of California EPN |
$346.18
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cash Price |
$479.60
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$252.64
|
| 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 |
$244.32
|
| Rate for Payer: Blue Shield of California Commercial |
$252.51
|
| Rate for Payer: Blue Shield of California EPN |
$165.15
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| 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: 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: InnovAge PACE Commercial |
$208.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.20
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$228.80
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| 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 Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.50
|
| 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 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 |
$261.25
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| 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 Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.02
|
| 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 |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$527.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.97
|
| Rate for Payer: Blue Shield of California Commercial |
$288.32
|
| Rate for Payer: Blue Shield of California EPN |
$188.57
|
| Rate for Payer: Cash Price |
$261.25
|
| Rate for Payer: Cash Price |
$261.25
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$135.12 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$587.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.51
|
| Rate for Payer: Blue Shield of California Commercial |
$587.58
|
| Rate for Payer: Blue Shield of California EPN |
$384.30
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Cash Price |
$532.40
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$532.40
|
| Rate for Payer: Central Health Plan Commercial |
$774.40
|
| 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 Permanente of CA Commercial/Self Funded |
$645.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$599.19
|
| 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 |
$135.12 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$587.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$623.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.51
|
| Rate for Payer: Blue Shield of California Commercial |
$587.58
|
| Rate for Payer: Blue Shield of California EPN |
$384.30
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Cash Price |
$532.40
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$822.80
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$532.40
|
| Rate for Payer: Central Health Plan Commercial |
$774.40
|
| 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 Permanente of CA Commercial/Self Funded |
$645.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$599.19
|
| 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 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 |
$293.93
|
| 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 |
$284.25
|
| Rate for Payer: Blue Shield of California Commercial |
$293.79
|
| Rate for Payer: Blue Shield of California EPN |
$192.15
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cash Price |
$266.20
|
| 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: 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: InnovAge PACE Commercial |
$242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$299.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$266.20
|
| Rate for Payer: Central Health Plan Commercial |
$387.20
|
| 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 Permanente of CA Commercial/Self Funded |
$322.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$299.60
|
| 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 |
905355990
|
|
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 |
$1,677.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,208.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,439.93
|
| Rate for Payer: Cash Price |
$1,571.35
|
| Rate for Payer: Cash Price |
$1,571.35
|
| 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: 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: InnovAge PACE Commercial |
$1,428.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,999.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
915355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$2,571.30 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,208.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,439.93
|
| Rate for Payer: Cash Price |
$1,571.35
|
| 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 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| 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 |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| 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
|
|
|
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: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,208.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,439.93
|
| Rate for Payer: Cash Price |
$1,571.35
|
| 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 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| 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 |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| 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
|
|
|
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 |
$1,677.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,208.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,439.93
|
| Rate for Payer: Cash Price |
$1,571.35
|
| Rate for Payer: Cash Price |
$1,571.35
|
| 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: 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: InnovAge PACE Commercial |
$1,428.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,999.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$1,449.90 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$886.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,208.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$946.14
|
| Rate for Payer: Blue Shield of California Commercial |
$977.88
|
| Rate for Payer: Blue Shield of California EPN |
$639.57
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,288.80
|
| Rate for Payer: Cigna of CA HMO |
$1,031.04
|
| Rate for Payer: Cigna of CA PPO |
$1,192.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,369.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,369.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$644.40
|
| Rate for Payer: Galaxy Health WC |
$1,369.35
|
| Rate for Payer: Global Benefits Group Commercial |
$966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,449.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.28
|
| Rate for Payer: InnovAge PACE Commercial |
$805.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,074.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$997.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.70
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: Networks By Design Commercial |
$1,047.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,369.35
|
| Rate for Payer: Riverside University Health System MISP |
$644.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$966.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$966.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$805.50
|
| Rate for Payer: United Healthcare All Other HMO |
$805.50
|
| Rate for Payer: United Healthcare HMO Rider |
$805.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$805.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,369.35
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$322.20 |
| Max. Negotiated Rate |
$1,449.90 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,288.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$644.40
|
| Rate for Payer: Galaxy Health WC |
$1,369.35
|
| Rate for Payer: Global Benefits Group Commercial |
$966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,449.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,074.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$997.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.20
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: Networks By Design Commercial |
$1,047.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,369.35
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Central Health Plan Commercial |
$909.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,023.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.40
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$194.29 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$690.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$625.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$852.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.76
|
| Rate for Payer: Blue Shield of California Commercial |
$690.16
|
| Rate for Payer: Blue Shield of California EPN |
$451.39
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Central Health Plan Commercial |
$909.60
|
| Rate for Payer: Cigna of CA HMO |
$727.68
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$966.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,023.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$194.29
|
| Rate for Payer: InnovAge PACE Commercial |
$568.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$795.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$795.90
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Riverside University Health System MISP |
$454.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$568.50
|
| Rate for Payer: United Healthcare All Other HMO |
$568.50
|
| Rate for Payer: United Healthcare HMO Rider |
$568.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$568.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.45
|
| Rate for Payer: Vantage Medical Group Senior |
$966.45
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Cash Price |
$1,435.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,349.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,696.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Cash Price |
$1,435.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,349.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,696.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
|
