|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$19,007.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$17,106.30 |
| Rate for Payer: Adventist Health Commercial |
$3,801.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Cash Price |
$8,553.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,205.60
|
| Rate for Payer: Cigna of CA HMO |
$12,164.48
|
| Rate for Payer: Cigna of CA PPO |
$14,065.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,304.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$16,155.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,404.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,106.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,069.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$988.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,801.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$14,255.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$12,354.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$16,155.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,503.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,503.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,503.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,503.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$150.07 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.07
|
| Rate for Payer: Blue Shield of California Commercial |
$132.93
|
| Rate for Payer: Blue Shield of California Commercial |
$95.76
|
| Rate for Payer: Blue Shield of California EPN |
$83.77
|
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Central Health Plan Commercial |
$168.80
|
| Rate for Payer: Cigna of CA HMO |
$135.04
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$156.14
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Central Health Plan Commercial |
$168.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: EPIC Health Plan Senior |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.20
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
915356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,080.28 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$2,604.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,493.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,764.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,694.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5,094.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,399.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,255.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,033.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,700.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,747.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,446.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,540.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,399.20
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
915356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.40 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: Adventist Health Commercial |
$1,270.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,094.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,033.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,747.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$4,128.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
905356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,080.28 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$2,604.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,493.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,764.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,694.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5,094.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,399.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,255.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,033.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,700.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,747.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,446.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,540.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,399.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,399.20
|
|
|
HC FLEX/EXT/ROTATION WRIST UNIT
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
CPT L6624
|
| Hospital Charge Code |
905356624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.40 |
| Max. Negotiated Rate |
$5,716.80 |
| Rate for Payer: Adventist Health Commercial |
$1,270.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,094.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,201.41
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,081.60
|
| Rate for Payer: Cigna of CA HMO |
$4,446.40
|
| Rate for Payer: Cigna of CA PPO |
$4,446.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,540.80
|
| Rate for Payer: Galaxy Health WC |
$5,399.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,716.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,033.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,747.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.40
|
| Rate for Payer: Multiplan Commercial |
$4,764.00
|
| Rate for Payer: Networks By Design Commercial |
$4,128.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,320.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,270.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.28
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
905356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,387.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,218.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
915356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,387.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,218.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
915356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.40 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$1,541.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,068.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,187.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,477.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,387.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,737.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,218.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,632.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,196.00
|
|
|
HC FLEX/EXT WRIST W/WO FRICTION
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT L6621
|
| Hospital Charge Code |
905356621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.40 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$1,541.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,068.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,187.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.04
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,632.00
|
| Rate for Payer: Cigna of CA PPO |
$2,632.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,477.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,387.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,737.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,218.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,632.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,411.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,343.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,196.00
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
OP
|
$679.42
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Adventist Health Commercial |
$135.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$577.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$373.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$509.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.22
|
| Rate for Payer: Blue Shield of California Commercial |
$430.75
|
| Rate for Payer: Blue Shield of California EPN |
$271.09
|
| Rate for Payer: Cash Price |
$305.74
|
| Rate for Payer: Central Health Plan Commercial |
$543.54
|
| Rate for Payer: Cigna of CA HMO |
$434.83
|
| Rate for Payer: Cigna of CA PPO |
$502.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$577.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$577.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$577.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.77
|
| Rate for Payer: EPIC Health Plan Senior |
$271.77
|
| Rate for Payer: Galaxy Health WC |
$577.51
|
| Rate for Payer: Global Benefits Group Commercial |
$407.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$611.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$475.59
|
| Rate for Payer: Multiplan Commercial |
$509.56
|
| Rate for Payer: Networks By Design Commercial |
$441.62
|
| Rate for Payer: Prime Health Services Commercial |
$577.51
|
| Rate for Payer: Riverside University Health System MISP |
$271.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.71
|
| Rate for Payer: United Healthcare All Other HMO |
$339.71
|
| Rate for Payer: United Healthcare HMO Rider |
$339.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$577.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$577.51
|
| Rate for Payer: Vantage Medical Group Senior |
$577.51
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
IP
|
$679.42
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Adventist Health Commercial |
$135.88
|
| Rate for Payer: Cash Price |
$305.74
|
| Rate for Payer: Central Health Plan Commercial |
$543.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.77
|
| Rate for Payer: EPIC Health Plan Senior |
$271.77
|
| Rate for Payer: Galaxy Health WC |
$577.51
|
| Rate for Payer: Global Benefits Group Commercial |
$407.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$611.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.88
|
| Rate for Payer: Multiplan Commercial |
$509.56
|
| Rate for Payer: Networks By Design Commercial |
$441.62
|
| Rate for Payer: Prime Health Services Commercial |
$577.51
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
OP
|
$1,696.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,272.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$986.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,075.26
|
| Rate for Payer: Blue Shield of California EPN |
$676.70
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,441.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$615.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,000.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,187.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Riverside University Health System MISP |
$678.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
IP
|
$1,696.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,000.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
IP
|
$1,951.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,755.90 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,560.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,365.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Senior |
$780.40
|
| Rate for Payer: Galaxy Health WC |
$1,658.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,755.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,238.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,151.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.20
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: Networks By Design Commercial |
$1,268.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,658.35
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
OP
|
$1,951.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,755.90 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,073.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,463.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$944.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,236.93
|
| Rate for Payer: Blue Shield of California EPN |
$778.45
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,560.80
|
| Rate for Payer: Cigna of CA HMO |
$1,248.64
|
| Rate for Payer: Cigna of CA PPO |
$1,443.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,658.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,365.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Senior |
$780.40
|
| Rate for Payer: Galaxy Health WC |
$1,658.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,755.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,238.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$708.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,151.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,365.70
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: Networks By Design Commercial |
$1,268.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,658.35
|
| Rate for Payer: Riverside University Health System MISP |
$780.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,170.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.50
|
| Rate for Payer: United Healthcare All Other HMO |
$975.50
|
| Rate for Payer: United Healthcare HMO Rider |
$975.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.35
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
IP
|
$1,696.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,000.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
OP
|
$1,696.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,272.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$986.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,075.26
|
| Rate for Payer: Blue Shield of California EPN |
$676.70
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,441.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$615.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,000.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,187.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Riverside University Health System MISP |
$678.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.99
|
| Rate for Payer: Blue Shield of California Commercial |
$358.47
|
| Rate for Payer: Blue Shield of California EPN |
$225.89
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$364.16
|
| Rate for Payer: Cigna of CA PPO |
$421.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.34
|
| Rate for Payer: Blue Shield of California Commercial |
$35.91
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$5.93
|
| Rate for Payer: EPIC Health Plan Senior |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$276.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.16
|
| Rate for Payer: Blue Shield of California Commercial |
$825.30
|
| Rate for Payer: Blue Shield of California EPN |
$520.07
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$838.40
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
