|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,771.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,918.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.26
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,949.44
|
| Rate for Payer: Cigna of CA PPO |
$2,254.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,827.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,827.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,161.40 |
| Max. Negotiated Rate |
$5,226.30 |
| Rate for Payer: Adventist Health Commercial |
$1,161.40
|
| Rate for Payer: Cash Price |
$2,613.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,645.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,064.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,322.80
|
| Rate for Payer: Galaxy Health WC |
$4,935.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,226.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,687.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.40
|
| Rate for Payer: Multiplan Commercial |
$4,355.25
|
| Rate for Payer: Networks By Design Commercial |
$3,774.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.95
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$1,161.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,833.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,116.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,833.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$553.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,377.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,658.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,305.38
|
| Rate for Payer: Cash Price |
$2,613.15
|
| Rate for Payer: Cash Price |
$2,613.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,645.60
|
| Rate for Payer: Cigna of CA HMO |
$3,716.48
|
| Rate for Payer: Cigna of CA PPO |
$4,297.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,116.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,833.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,064.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,674.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3,116.47
|
| Rate for Payer: Galaxy Health WC |
$4,935.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,226.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,646.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,833.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,687.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,966.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,796.42
|
| Rate for Payer: Multiplan Commercial |
$4,355.25
|
| Rate for Payer: Networks By Design Commercial |
$3,774.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,833.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,003.14
|
| Rate for Payer: Riverside University Health System MISP |
$3,116.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,041.28
|
| Rate for Payer: United Healthcare All Other HMO |
$7,041.28
|
| Rate for Payer: United Healthcare HMO Rider |
$7,041.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,041.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,833.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,116.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2,833.15
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$537.20 |
| Max. Negotiated Rate |
$2,417.40 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,148.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,880.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.40
|
| Rate for Payer: Galaxy Health WC |
$2,283.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,611.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,417.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,705.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,584.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.20
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
| Rate for Payer: Networks By Design Commercial |
$1,745.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.10
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$537.20 |
| Max. Negotiated Rate |
$3,256.45 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,665.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,975.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,562.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,692.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.34
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,148.80
|
| Rate for Payer: Cigna of CA HMO |
$1,719.04
|
| Rate for Payer: Cigna of CA PPO |
$1,987.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,880.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Galaxy Health WC |
$2,283.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,611.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,417.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$743.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,705.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$821.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
| Rate for Payer: Networks By Design Commercial |
$1,745.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,765.04
|
| Rate for Payer: Riverside University Health System MISP |
$1,831.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,611.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,611.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,256.45
|
| Rate for Payer: United Healthcare All Other HMO |
$3,256.45
|
| Rate for Payer: United Healthcare HMO Rider |
$3,256.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$2,741.40 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.40
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$5,833.65 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,833.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,771.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,918.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.26
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,949.44
|
| Rate for Payer: Cigna of CA PPO |
$2,254.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,415.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,563.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,827.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,827.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.89
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
905352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.89
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.51
|
| Rate for Payer: Blue Shield of California Commercial |
$117.89
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
905352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.51
|
| Rate for Payer: Blue Shield of California Commercial |
$117.89
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$239.11 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.14
|
| Rate for Payer: Blue Shield of California Commercial |
$55.44
|
| Rate for Payer: Blue Shield of California EPN |
$34.94
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$447.15 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.15
|
| Rate for Payer: Blue Shield of California Commercial |
$146.16
|
| Rate for Payer: Blue Shield of California EPN |
$92.10
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$645.11
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: Cigna of CA HMO |
$709.76
|
| Rate for Payer: Cigna of CA PPO |
$820.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$776.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.53
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$553.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.34
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.03
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
| Rate for Payer: Prime Health Services Medicare |
$418.73
|
| Rate for Payer: Riverside University Health System MISP |
$434.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$665.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$665.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Vantage Medical Group Senior |
$395.03
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$776.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.60
|
| Rate for Payer: EPIC Health Plan Senior |
$443.60
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$654.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
915352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.12
|
| Rate for Payer: Blue Shield of California Commercial |
$433.08
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$433.08
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.12
|
| Rate for Payer: Blue Shield of California Commercial |
$433.08
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
915352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$433.08
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.84
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.84
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
