|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,848.12 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,834.98
|
| Rate for Payer: Blue Shield of California Commercial |
$9,423.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,265.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,817.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,423.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,350.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$7,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.40
|
| Rate for Payer: Blue Shield of California Commercial |
$296.10
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.45
|
| Rate for Payer: Blue Shield of California Commercial |
$213.02
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health System MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.45
|
| Rate for Payer: Blue Shield of California Commercial |
$213.02
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health System MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$230.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$159.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.38
|
| Rate for Payer: Blue Shield of California Commercial |
$208.59
|
| Rate for Payer: Blue Shield of California EPN |
$131.27
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: Cigna of CA HMO |
$210.56
|
| Rate for Payer: Cigna of CA PPO |
$243.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$279.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$279.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$279.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$230.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$230.30
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
| Rate for Payer: Riverside University Health System MISP |
$131.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.50
|
| Rate for Payer: United Healthcare All Other HMO |
$164.50
|
| Rate for Payer: United Healthcare HMO Rider |
$164.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$279.65
|
| Rate for Payer: Vantage Medical Group Senior |
$279.65
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$587.60
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$1,357.16 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,357.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$873.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$525.86
|
| Rate for Payer: Blue Shield of California Commercial |
$569.52
|
| Rate for Payer: Blue Shield of California EPN |
$358.89
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$578.56
|
| Rate for Payer: Cigna of CA PPO |
$668.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$587.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
905356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,810.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
915356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,810.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
915356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.35 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$2,459.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,498.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,489.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4,810.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,098.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,098.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,232.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,465.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,198.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$2,999.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
905356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.35 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$2,459.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,498.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,489.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4,810.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,098.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,098.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,232.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,465.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,198.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$2,999.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.44
|
| Rate for Payer: Cigna of CA HMO |
$2.75
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.01
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.15
|
| Rate for Payer: United Healthcare HMO Rider |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3.65
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
|
OP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$6.02
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Senior |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
| Rate for Payer: Riverside University Health System MISP |
$3.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Vantage Medical Group Senior |
$7.99
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
|
IP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.74
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Senior |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 240
|
Facility
|
OP
|
$2.95
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
909081005
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$2.21
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.51
|
| Rate for Payer: Riverside University Health System MISP |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.51
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 240
|
Facility
|
IP
|
$2.95
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
909081005
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$2.21
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.51
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 300
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081006
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Riverside University Health System MISP |
$1.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 300
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081006
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$3.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
| Rate for Payer: Riverside University Health System MISP |
$1.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
