|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$4,102.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| 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 |
$2,734.80
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,646.40
|
| Rate for Payer: Cigna of CA PPO |
$3,372.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,874.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,734.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,102.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,418.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,040.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| Rate for Payer: Networks By Design Commercial |
$2,962.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,874.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,734.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,279.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,279.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,279.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,279.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
IP
|
$13,027.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,605.40 |
| Max. Negotiated Rate |
$11,724.30 |
| Rate for Payer: Cash Price |
$5,862.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,210.80
|
| Rate for Payer: Galaxy Health WC |
$11,072.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,816.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,724.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,963.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,605.40
|
| Rate for Payer: Multiplan Commercial |
$9,770.25
|
| Rate for Payer: Networks By Design Commercial |
$8,467.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,072.95
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,438.40 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,315.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Cigna of CA PPO |
$5,322.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,394.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$4,638.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$927.60 |
| Max. Negotiated Rate |
$4,174.20 |
| Rate for Payer: Cash Price |
$2,087.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,710.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,855.20
|
| Rate for Payer: Galaxy Health WC |
$3,942.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,782.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,174.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,093.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,767.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.60
|
| Rate for Payer: Multiplan Commercial |
$3,478.50
|
| Rate for Payer: Networks By Design Commercial |
$3,014.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,942.30
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$4,638.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.15 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,782.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,087.10
|
| Rate for Payer: Cash Price |
$2,087.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,710.40
|
| Rate for Payer: Cigna of CA PPO |
$3,432.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,942.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,782.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,174.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,093.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,478.50
|
| Rate for Payer: Networks By Design Commercial |
$3,014.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,942.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,782.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$1,965.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,473.75
|
| Rate for Payer: Cash Price |
$1,473.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,620.00
|
| Rate for Payer: Cigna of CA PPO |
$2,423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,783.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,965.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,947.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,456.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,184.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,456.25
|
| Rate for Payer: Networks By Design Commercial |
$2,128.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,783.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,965.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.00 |
| Max. Negotiated Rate |
$2,947.50 |
| Rate for Payer: Cash Price |
$1,473.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,310.00
|
| Rate for Payer: Galaxy Health WC |
$2,783.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,965.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,947.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,184.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,247.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.00
|
| Rate for Payer: Multiplan Commercial |
$2,456.25
|
| Rate for Payer: Networks By Design Commercial |
$2,128.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,783.75
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$5,288.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,057.60 |
| Max. Negotiated Rate |
$4,759.20 |
| Rate for Payer: Cash Price |
$2,379.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.20
|
| Rate for Payer: Galaxy Health WC |
$4,494.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,759.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,527.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,014.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,057.60
|
| Rate for Payer: Multiplan Commercial |
$3,966.00
|
| Rate for Payer: Networks By Design Commercial |
$3,437.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,494.80
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$5,288.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.45 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,379.60
|
| Rate for Payer: Cash Price |
$2,379.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,230.40
|
| Rate for Payer: Cigna of CA PPO |
$3,913.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,494.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,759.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,966.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,527.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,057.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,966.00
|
| Rate for Payer: Networks By Design Commercial |
$3,437.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,494.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.01
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Caremore Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$238.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.48
|
| Rate for Payer: Blue Distinction Transplant |
$17.40
|
| Rate for Payer: Blue Shield of California Commercial |
$17.92
|
| Rate for Payer: Blue Shield of California EPN |
$14.09
|
| Rate for Payer: Caremore Medicare Advantage |
$35.74
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Media |
$35.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.74
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: InnovAge PACE Commercial |
$53.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.89
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Prime Health Services Medicare |
$37.88
|
| Rate for Payer: Riverside University Health System MISP |
$39.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.95
|
| Rate for Payer: United Healthcare All Other HMO |
$28.95
|
| Rate for Payer: United Healthcare HMO Rider |
$28.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Shield of California EPN |
$81.17
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.40
|
| Rate for Payer: United Healthcare All Other HMO |
$56.06
|
| Rate for Payer: United Healthcare HMO Rider |
$54.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.16
|
|
|
HC IMMOBILIZER KNEE 16IN 3 PANEL
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California EPN |
$82.69
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.32
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
IP
|
$95.61
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$86.05 |
| Rate for Payer: Blue Shield of California EPN |
$51.06
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Central Health Plan Commercial |
$76.49
|
| Rate for Payer: Cigna of CA HMO |
$66.93
|
| Rate for Payer: Cigna of CA PPO |
$66.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.24
|
| Rate for Payer: Galaxy Health WC |
$81.27
|
| Rate for Payer: Global Benefits Group Commercial |
$57.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$71.71
|
| Rate for Payer: Networks By Design Commercial |
$47.80
|
| Rate for Payer: Prime Health Services Commercial |
$81.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.10
|
| Rate for Payer: United Healthcare All Other HMO |
$35.26
|
| Rate for Payer: United Healthcare HMO Rider |
$34.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.55
|
|
|
HC IMMOBILIZER KNEE 20"
|
Facility
|
OP
|
$95.61
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606441
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.46 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.49
|
| Rate for Payer: Blue Distinction Transplant |
$57.37
|
| Rate for Payer: Blue Shield of California Commercial |
$71.71
|
| Rate for Payer: Blue Shield of California EPN |
$52.01
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Central Health Plan Commercial |
$76.49
|
| Rate for Payer: Cigna of CA HMO |
$66.93
|
| Rate for Payer: Cigna of CA PPO |
$66.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.27
|
| Rate for Payer: Dignity Health Media |
$81.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.24
|
| Rate for Payer: Galaxy Health WC |
$81.27
|
| Rate for Payer: Global Benefits Group Commercial |
$57.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$71.71
|
| Rate for Payer: Networks By Design Commercial |
$47.80
|
| Rate for Payer: Prime Health Services Commercial |
$81.27
|
| Rate for Payer: Riverside University Health System MISP |
$38.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.80
|
| Rate for Payer: United Healthcare All Other HMO |
$47.80
|
| Rate for Payer: United Healthcare HMO Rider |
$47.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.27
|
| Rate for Payer: Vantage Medical Group Senior |
$81.27
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
IP
|
$107.24
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Blue Shield of California EPN |
$57.27
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Central Health Plan Commercial |
$85.79
|
| Rate for Payer: Cigna of CA HMO |
$75.07
|
| Rate for Payer: Cigna of CA PPO |
$75.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.90
|
| Rate for Payer: Galaxy Health WC |
$91.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Multiplan Commercial |
$80.43
|
| Rate for Payer: Networks By Design Commercial |
$53.62
|
| Rate for Payer: Prime Health Services Commercial |
$91.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.49
|
| Rate for Payer: United Healthcare All Other HMO |
$39.55
|
| Rate for Payer: United Healthcare HMO Rider |
$38.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.39
|
|
|
HC IMMOBILIZER KNEE 22"
|
Facility
|
OP
|
$107.24
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901606442
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.53 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.36
|
| Rate for Payer: Blue Distinction Transplant |
$64.34
|
| Rate for Payer: Blue Shield of California Commercial |
$80.43
|
| Rate for Payer: Blue Shield of California EPN |
$58.34
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Cash Price |
$48.26
|
| Rate for Payer: Central Health Plan Commercial |
$85.79
|
| Rate for Payer: Cigna of CA HMO |
$75.07
|
| Rate for Payer: Cigna of CA PPO |
$75.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.15
|
| Rate for Payer: Dignity Health Media |
$91.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.90
|
| Rate for Payer: Galaxy Health WC |
$91.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$80.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.97
|
| Rate for Payer: Multiplan Commercial |
$80.43
|
| Rate for Payer: Networks By Design Commercial |
$53.62
|
| Rate for Payer: Prime Health Services Commercial |
$91.15
|
| Rate for Payer: Riverside University Health System MISP |
$42.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.62
|
| Rate for Payer: United Healthcare All Other HMO |
$53.62
|
| Rate for Payer: United Healthcare HMO Rider |
$53.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.15
|
| Rate for Payer: Vantage Medical Group Senior |
$91.15
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Shield of California EPN |
$81.17
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.40
|
| Rate for Payer: United Healthcare All Other HMO |
$56.06
|
| Rate for Payer: United Healthcare HMO Rider |
$54.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.16
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 16
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California EPN |
$82.69
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.32
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Shield of California EPN |
$81.17
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.40
|
| Rate for Payer: United Healthcare All Other HMO |
$56.06
|
| Rate for Payer: United Healthcare HMO Rider |
$54.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.16
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California EPN |
$82.69
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.32
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
IP
|
$242.48
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$218.23 |
| Rate for Payer: Blue Shield of California EPN |
$129.48
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Central Health Plan Commercial |
$193.98
|
| Rate for Payer: Cigna of CA HMO |
$169.74
|
| Rate for Payer: Cigna of CA PPO |
$169.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.99
|
| Rate for Payer: Galaxy Health WC |
$206.11
|
| Rate for Payer: Global Benefits Group Commercial |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$181.86
|
| Rate for Payer: Networks By Design Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Commercial |
$206.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.56
|
| Rate for Payer: United Healthcare All Other HMO |
$89.43
|
| Rate for Payer: United Healthcare HMO Rider |
$87.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.02
|
|
|
HC IMMOBILIZER LEG PEDS 11" PAIR
|
Facility
|
OP
|
$242.48
|
|
| Hospital Charge Code |
901698338
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$218.23 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.26
|
| Rate for Payer: Blue Distinction Transplant |
$145.49
|
| Rate for Payer: Blue Shield of California Commercial |
$181.86
|
| Rate for Payer: Blue Shield of California EPN |
$131.91
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Central Health Plan Commercial |
$193.98
|
| Rate for Payer: Cigna of CA HMO |
$169.74
|
| Rate for Payer: Cigna of CA PPO |
$169.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.11
|
| Rate for Payer: Dignity Health Media |
$206.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.99
|
| Rate for Payer: Galaxy Health WC |
$206.11
|
| Rate for Payer: Global Benefits Group Commercial |
$145.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.42
|
| Rate for Payer: Multiplan Commercial |
$181.86
|
| Rate for Payer: Networks By Design Commercial |
$121.24
|
| Rate for Payer: Prime Health Services Commercial |
$206.11
|
| Rate for Payer: Riverside University Health System MISP |
$96.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.24
|
| Rate for Payer: United Healthcare All Other HMO |
$121.24
|
| Rate for Payer: United Healthcare HMO Rider |
$121.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.11
|
| Rate for Payer: Vantage Medical Group Senior |
$206.11
|
|
