|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Central Health Plan Commercial |
$452.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$509.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.20
|
| Rate for Payer: Multiplan Commercial |
$424.50
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$2,696.00 |
| 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 |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$339.60
|
| Rate for Payer: Caremore Medicare Advantage |
$248.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Central Health Plan Commercial |
$452.80
|
| Rate for Payer: Cigna of CA PPO |
$418.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$509.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$424.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$408.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: InnovAge PACE Commercial |
$373.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$424.50
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: Prime Health Services Medicare |
$263.91
|
| Rate for Payer: Riverside University Health System MISP |
$273.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.00
|
| Rate for Payer: United Healthcare All Other HMO |
$283.00
|
| Rate for Payer: United Healthcare HMO Rider |
$283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$14,372.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,874.40 |
| Max. Negotiated Rate |
$12,934.80 |
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,748.80
|
| Rate for Payer: Galaxy Health WC |
$12,216.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,623.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,934.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,586.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,475.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,874.40
|
| Rate for Payer: Multiplan Commercial |
$10,779.00
|
| Rate for Payer: Networks By Design Commercial |
$9,341.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,216.20
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$14,372.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$987.96 |
| Max. Negotiated Rate |
$12,934.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,623.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,039.99
|
| Rate for Payer: Blue Shield of California EPN |
$7,027.91
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,497.60
|
| Rate for Payer: Cigna of CA HMO |
$9,198.08
|
| Rate for Payer: Cigna of CA PPO |
$10,635.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$12,216.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,623.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,934.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,779.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,586.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$987.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,874.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,779.00
|
| Rate for Payer: Networks By Design Commercial |
$9,341.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,216.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,623.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,623.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$14,372.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,874.40 |
| Max. Negotiated Rate |
$12,934.80 |
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,748.80
|
| Rate for Payer: Galaxy Health WC |
$12,216.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,623.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,934.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,586.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,475.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,874.40
|
| Rate for Payer: Multiplan Commercial |
$10,779.00
|
| Rate for Payer: Networks By Design Commercial |
$9,341.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,216.20
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$14,372.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,934.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,623.20
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,497.60
|
| Rate for Payer: Cigna of CA PPO |
$10,635.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$12,216.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,623.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,934.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,779.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,586.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$987.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,874.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,779.00
|
| Rate for Payer: Networks By Design Commercial |
$9,341.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,216.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,623.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.60
|
| 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: Anthem Blue Cross of CA Exchange |
$107.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.67
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.60
|
| Rate for Payer: Dignity Health Media |
$13.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: InnovAge PACE Commercial |
$20.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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 HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
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 |
$2,223.20 |
| Max. Negotiated Rate |
$5,716.80 |
| 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 |
$3,493.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,075.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,752.76
|
| Rate for Payer: Blue Distinction Transplant |
$3,811.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,764.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,455.49
|
| 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 Media |
$5,399.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$4,764.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,223.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.32
|
| 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 |
$3,176.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,176.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,176.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,176.00
|
| 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: Blue Shield of California EPN |
$3,391.97
|
| 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: EPIC Health Plan Commercial |
$2,540.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$4,236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,420.11
|
| 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 |
$3,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,399.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,398.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,342.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,291.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,096.16
|
|
|
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: Blue Shield of California EPN |
$2,007.84
|
| 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: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| 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 |
$1,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,419.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,386.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,356.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,240.80
|
|
|
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 |
$1,316.00 |
| Max. Negotiated Rate |
$3,384.00 |
| 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 |
$2,068.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,820.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,221.41
|
| Rate for Payer: Blue Distinction Transplant |
$2,256.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,820.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,045.44
|
| 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 Media |
$3,196.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,820.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,316.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,737.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.60
|
| 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 |
$1,880.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,880.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,880.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,880.00
|
| 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
|
IP
|
$773.58
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.72 |
| Max. Negotiated Rate |
$696.22 |
| Rate for Payer: Cash Price |
$348.11
|
| Rate for Payer: Central Health Plan Commercial |
$618.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.43
|
| Rate for Payer: Galaxy Health WC |
$657.54
|
| Rate for Payer: Global Benefits Group Commercial |
$464.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.72
|
| Rate for Payer: Multiplan Commercial |
$580.18
|
| Rate for Payer: Networks By Design Commercial |
$502.83
|
| Rate for Payer: Prime Health Services Commercial |
$657.54
|
|
|
HC FLEXISEAL FECAL SYSTEM MGMT
|
Facility
|
OP
|
$773.58
|
|
| Hospital Charge Code |
901698766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.72 |
| Max. Negotiated Rate |
$696.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$469.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$425.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$374.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.03
|
| Rate for Payer: Blue Distinction Transplant |
$464.15
|
| Rate for Payer: Blue Shield of California Commercial |
$486.58
|
| Rate for Payer: Blue Shield of California EPN |
$378.28
|
| Rate for Payer: Cash Price |
$348.11
|
| Rate for Payer: Central Health Plan Commercial |
$618.86
|
| Rate for Payer: Cigna of CA HMO |
$495.09
|
| Rate for Payer: Cigna of CA PPO |
$572.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.54
|
| Rate for Payer: Dignity Health Media |
$657.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$309.43
|
| Rate for Payer: Galaxy Health WC |
$657.54
|
| Rate for Payer: Global Benefits Group Commercial |
$464.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$580.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.72
|
| Rate for Payer: Multiplan Commercial |
$580.18
|
| Rate for Payer: Networks By Design Commercial |
$502.83
|
| Rate for Payer: Prime Health Services Commercial |
$657.54
|
| Rate for Payer: Riverside University Health System MISP |
$309.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.79
|
| Rate for Payer: United Healthcare All Other HMO |
$386.79
|
| Rate for Payer: United Healthcare HMO Rider |
$386.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.54
|
| Rate for Payer: Vantage Medical Group Senior |
$657.54
|
|
|
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: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| 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
|
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: 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 |
$932.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,017.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.78
|
| Rate for Payer: Blue Shield of California EPN |
$829.34
|
| 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 Media |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$593.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| 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
|
| 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 Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
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: 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 |
$1,073.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$944.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,152.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,170.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.18
|
| Rate for Payer: Blue Shield of California EPN |
$954.04
|
| 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 Media |
$1,658.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,658.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,463.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,301.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.33
|
| 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
|
| 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 Medi-Cal |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.35
|
|
|
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: Cash Price |
$877.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,560.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1,301.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.33
|
| 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 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: 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 |
$932.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,017.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.78
|
| Rate for Payer: Blue Shield of California EPN |
$829.34
|
| 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 Media |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$593.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| 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
|
| 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 Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
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: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| 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 FLOW VOLUME STUDY
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Central Health Plan Commercial |
$383.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.80
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.99
|
| Rate for Payer: Blue Distinction Transplant |
$287.40
|
| Rate for Payer: Blue Shield of California Commercial |
$296.02
|
| Rate for Payer: Blue Shield of California EPN |
$232.79
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Central Health Plan Commercial |
$383.20
|
| Rate for Payer: Cigna of CA HMO |
$306.56
|
| Rate for Payer: Cigna of CA PPO |
$354.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| 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: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.67
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$5.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.76 |
| Max. Negotiated Rate |
$1,206.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$535.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$276.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.05
|
| Rate for Payer: Blue Distinction Transplant |
$804.00
|
| Rate for Payer: Blue Shield of California Commercial |
$828.12
|
| Rate for Payer: Blue Shield of California EPN |
$651.24
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,072.00
|
| Rate for Payer: Cigna of CA HMO |
$857.60
|
| Rate for Payer: Cigna of CA PPO |
$991.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Dignity Health Media |
$1,139.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$536.00
|
| Rate for Payer: Galaxy Health WC |
$1,139.00
|
| Rate for Payer: Global Benefits Group Commercial |
$804.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,206.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,005.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$469.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.00
|
| Rate for Payer: Multiplan Commercial |
$1,005.00
|
| Rate for Payer: Networks By Design Commercial |
$871.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.00
|
| Rate for Payer: Riverside University Health System MISP |
$536.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.00
|
| Rate for Payer: United Healthcare All Other HMO |
$670.00
|
| Rate for Payer: United Healthcare HMO Rider |
$670.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.00
|
|
