|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$6,134.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.98 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,907.20
|
| Rate for Payer: Cigna of CA HMO |
$3,925.76
|
| Rate for Payer: Cigna of CA PPO |
$4,539.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,213.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,520.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,091.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,987.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,213.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,680.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$6,134.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,226.80 |
| Max. Negotiated Rate |
$5,520.60 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,453.60
|
| Rate for Payer: Galaxy Health WC |
$5,213.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,520.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,091.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,337.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,796.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.80
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
| Rate for Payer: Networks By Design Commercial |
$3,987.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,213.90
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$4,331.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$866.20 |
| Max. Negotiated Rate |
$3,897.90 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Cash Price |
$2,382.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,464.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,732.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,732.40
|
| Rate for Payer: Galaxy Health WC |
$3,681.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,598.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,888.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,650.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,680.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.20
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
| Rate for Payer: Networks By Design Commercial |
$2,815.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,681.35
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$4,331.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$866.20 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,382.05
|
| Rate for Payer: Cash Price |
$2,382.05
|
| Rate for Payer: Cash Price |
$2,382.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,464.80
|
| Rate for Payer: Cigna of CA HMO |
$2,771.84
|
| Rate for Payer: Cigna of CA PPO |
$3,204.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,681.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,598.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,897.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,023.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,888.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,815.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,681.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,598.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$6,993.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.34 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,398.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,846.15
|
| Rate for Payer: Cash Price |
$3,846.15
|
| Rate for Payer: Cash Price |
$3,846.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,594.40
|
| Rate for Payer: Cigna of CA HMO |
$4,475.52
|
| Rate for Payer: Cigna of CA PPO |
$5,174.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,944.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,195.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,293.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$5,244.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,545.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,944.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,195.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$6,993.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,398.60 |
| Max. Negotiated Rate |
$6,293.70 |
| Rate for Payer: Adventist Health Commercial |
$1,398.60
|
| Rate for Payer: Cash Price |
$3,846.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,594.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,797.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,797.20
|
| Rate for Payer: Galaxy Health WC |
$5,944.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,195.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,293.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,664.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,328.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.60
|
| Rate for Payer: Multiplan Commercial |
$5,244.75
|
| Rate for Payer: Networks By Design Commercial |
$4,545.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,944.05
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$10.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$195.52 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.68
|
| Rate for Payer: Blue Shield of California Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.25
|
| Rate for Payer: EPIC Health Plan Senior |
$35.74
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: InnovAge PACE Commercial |
$53.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.89
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.74
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$37.88
|
| Rate for Payer: Riverside University Health System MISP |
$39.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.95
|
| Rate for Payer: United Healthcare All Other HMO |
$28.95
|
| Rate for Payer: United Healthcare HMO Rider |
$28.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
OP
|
$154.91
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$139.42 |
| Rate for Payer: Adventist Health Commercial |
$63.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$78.07
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Central Health Plan Commercial |
$123.93
|
| Rate for Payer: Cigna of CA HMO |
$108.44
|
| Rate for Payer: Cigna of CA PPO |
$108.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.96
|
| Rate for Payer: EPIC Health Plan Senior |
$61.96
|
| Rate for Payer: Galaxy Health WC |
$131.67
|
| Rate for Payer: Global Benefits Group Commercial |
$92.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$77.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.44
|
| Rate for Payer: Multiplan Commercial |
$116.18
|
| Rate for Payer: Networks By Design Commercial |
$77.45
|
| Rate for Payer: Prime Health Services Commercial |
$131.67
|
| Rate for Payer: Riverside University Health System MISP |
$61.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other HMO |
$56.59
|
| Rate for Payer: United Healthcare HMO Rider |
$55.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.67
|
| Rate for Payer: Vantage Medical Group Senior |
$131.67
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
IP
|
$154.91
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$139.42 |
| Rate for Payer: Adventist Health Commercial |
$30.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$78.07
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Central Health Plan Commercial |
$123.93
|
| Rate for Payer: Cigna of CA HMO |
$108.44
|
| Rate for Payer: Cigna of CA PPO |
$108.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.96
|
| Rate for Payer: EPIC Health Plan Senior |
$61.96
|
| Rate for Payer: Galaxy Health WC |
$131.67
|
| Rate for Payer: Global Benefits Group Commercial |
$92.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.98
|
| Rate for Payer: Multiplan Commercial |
$116.18
|
| Rate for Payer: Networks By Design Commercial |
$100.69
|
| Rate for Payer: Prime Health Services Commercial |
$131.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other HMO |
$56.59
|
| Rate for Payer: United Healthcare HMO Rider |
$55.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.73
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
OP
|
$99.94
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.69
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$49.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$49.97
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Riverside University Health System MISP |
$39.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
IP
|
$99.94
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$69.96
|
| Rate for Payer: Cigna of CA PPO |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.51
|
| Rate for Payer: United Healthcare All Other HMO |
$36.51
|
| Rate for Payer: United Healthcare HMO Rider |
$35.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
IP
|
$112.02
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Blue Shield of California Commercial |
$86.59
|
| Rate for Payer: Blue Shield of California EPN |
$56.46
|
| Rate for Payer: Cash Price |
$61.61
|
| Rate for Payer: Central Health Plan Commercial |
$89.62
|
| Rate for Payer: Cigna of CA HMO |
$78.41
|
| Rate for Payer: Cigna of CA PPO |
$78.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.81
|
| Rate for Payer: EPIC Health Plan Senior |
$44.81
|
| Rate for Payer: Galaxy Health WC |
$95.22
|
| Rate for Payer: Global Benefits Group Commercial |
$67.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.02
|
| Rate for Payer: Networks By Design Commercial |
$72.81
|
| Rate for Payer: Prime Health Services Commercial |
$95.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.04
|
| Rate for Payer: United Healthcare All Other HMO |
$40.92
|
| Rate for Payer: United Healthcare HMO Rider |
$40.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.69
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
OP
|
$112.02
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$45.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.79
|
| Rate for Payer: Blue Shield of California Commercial |
$86.59
|
| Rate for Payer: Blue Shield of California EPN |
$56.46
|
| Rate for Payer: Cash Price |
$61.61
|
| Rate for Payer: Cash Price |
$61.61
|
| Rate for Payer: Central Health Plan Commercial |
$89.62
|
| Rate for Payer: Cigna of CA HMO |
$78.41
|
| Rate for Payer: Cigna of CA PPO |
$78.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.81
|
| Rate for Payer: EPIC Health Plan Senior |
$44.81
|
| Rate for Payer: Galaxy Health WC |
$95.22
|
| Rate for Payer: Global Benefits Group Commercial |
$67.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.41
|
| Rate for Payer: Multiplan Commercial |
$84.02
|
| Rate for Payer: Networks By Design Commercial |
$56.01
|
| Rate for Payer: Prime Health Services Commercial |
$95.22
|
| Rate for Payer: Riverside University Health System MISP |
$44.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.04
|
| Rate for Payer: United Healthcare All Other HMO |
$40.92
|
| Rate for Payer: United Healthcare HMO Rider |
$40.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.22
|
| Rate for Payer: Vantage Medical Group Senior |
$95.22
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$62.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.81
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
IP
|
$273.21
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$54.64
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$150.27
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$177.59
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
OP
|
$273.21
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$112.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.46
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$150.27
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: InnovAge PACE Commercial |
$136.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$136.60
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: Riverside University Health System MISP |
$109.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Vantage Medical Group Senior |
$232.23
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
IP
|
$294.63
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Blue Shield of California Commercial |
$227.75
|
| Rate for Payer: Blue Shield of California EPN |
$148.49
|
| Rate for Payer: Cash Price |
$162.05
|
| Rate for Payer: Central Health Plan Commercial |
$235.70
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.93
|
| Rate for Payer: Multiplan Commercial |
$220.97
|
| Rate for Payer: Networks By Design Commercial |
$191.51
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.57
|
| Rate for Payer: United Healthcare All Other HMO |
$107.63
|
| Rate for Payer: United Healthcare HMO Rider |
$105.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.49
|
|
|
HC IMMOBILIZER LEG PEDS 13" PAIR
|
Facility
|
OP
|
$294.63
|
|
| Hospital Charge Code |
901698339
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$265.17 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.04
|
| Rate for Payer: Blue Shield of California Commercial |
$227.75
|
| Rate for Payer: Blue Shield of California EPN |
$148.49
|
| Rate for Payer: Cash Price |
$162.05
|
| Rate for Payer: Central Health Plan Commercial |
$235.70
|
| Rate for Payer: Cigna of CA HMO |
$206.24
|
| Rate for Payer: Cigna of CA PPO |
$206.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.85
|
| Rate for Payer: EPIC Health Plan Senior |
$117.85
|
| Rate for Payer: Galaxy Health WC |
$250.44
|
| Rate for Payer: Global Benefits Group Commercial |
$176.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.17
|
| Rate for Payer: InnovAge PACE Commercial |
$147.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.24
|
| Rate for Payer: Multiplan Commercial |
$220.97
|
| Rate for Payer: Networks By Design Commercial |
$147.31
|
| Rate for Payer: Prime Health Services Commercial |
$250.44
|
| Rate for Payer: Riverside University Health System MISP |
$117.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.57
|
| Rate for Payer: United Healthcare All Other HMO |
$107.63
|
| Rate for Payer: United Healthcare HMO Rider |
$105.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.44
|
| Rate for Payer: Vantage Medical Group Senior |
$250.44
|
|
|
HC IMMOBILIZER, LEG PEDS 7" PAIR
|
Facility
|
IP
|
$273.21
|
|
| Hospital Charge Code |
901698336
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$245.89 |
| Rate for Payer: Adventist Health Commercial |
$54.64
|
| Rate for Payer: Blue Shield of California Commercial |
$211.19
|
| Rate for Payer: Blue Shield of California EPN |
$137.70
|
| Rate for Payer: Cash Price |
$150.27
|
| Rate for Payer: Central Health Plan Commercial |
$218.57
|
| Rate for Payer: Cigna of CA HMO |
$191.25
|
| Rate for Payer: Cigna of CA PPO |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.28
|
| Rate for Payer: EPIC Health Plan Senior |
$109.28
|
| Rate for Payer: Galaxy Health WC |
$232.23
|
| Rate for Payer: Global Benefits Group Commercial |
$163.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$204.91
|
| Rate for Payer: Networks By Design Commercial |
$177.59
|
| Rate for Payer: Prime Health Services Commercial |
$232.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.54
|
| Rate for Payer: United Healthcare All Other HMO |
$99.80
|
| Rate for Payer: United Healthcare HMO Rider |
$97.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.48
|
|
