|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$1,627.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$1,464.30 |
| Rate for Payer: Adventist Health Commercial |
$325.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$604.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$955.54
|
| Rate for Payer: Blue Shield of California Commercial |
$987.59
|
| Rate for Payer: Blue Shield of California EPN |
$645.92
|
| Rate for Payer: Cash Price |
$894.85
|
| Rate for Payer: Cash Price |
$894.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,301.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.28
|
| Rate for Payer: Cigna of CA PPO |
$1,203.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,382.95
|
| Rate for Payer: Global Benefits Group Commercial |
$976.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,464.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,220.25
|
| Rate for Payer: Networks By Design Commercial |
$1,057.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.95
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$976.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$1,627.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$325.40 |
| Max. Negotiated Rate |
$1,464.30 |
| Rate for Payer: Adventist Health Commercial |
$325.40
|
| Rate for Payer: Cash Price |
$894.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,301.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.80
|
| Rate for Payer: EPIC Health Plan Senior |
$650.80
|
| Rate for Payer: Galaxy Health WC |
$1,382.95
|
| Rate for Payer: Global Benefits Group Commercial |
$976.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,464.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.40
|
| Rate for Payer: Multiplan Commercial |
$1,220.25
|
| Rate for Payer: Networks By Design Commercial |
$1,057.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.95
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,720.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$860.00
|
| Rate for Payer: EPIC Health Plan Senior |
$860.00
|
| Rate for Payer: Galaxy Health WC |
$1,827.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,290.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,935.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,434.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,330.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.00
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: Networks By Design Commercial |
$1,397.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,827.50
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,305.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$718.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,262.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,305.05
|
| Rate for Payer: Blue Shield of California EPN |
$853.55
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,376.00
|
| Rate for Payer: Cigna of CA PPO |
$1,591.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,827.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,290.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,935.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,434.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: Networks By Design Commercial |
$1,397.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,827.50
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,290.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,290.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,848.12 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,900.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9,082.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,817.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,225.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,082.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,350.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$7,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,082.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,350.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$7,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,848.12 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,900.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9,082.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,817.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,225.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.03
|
| Rate for Payer: Blue Shield of California Commercial |
$285.29
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.33
|
| Rate for Payer: Blue Shield of California Commercial |
$205.30
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: InnovAge PACE Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health System MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.33
|
| Rate for Payer: Blue Shield of California Commercial |
$205.30
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: InnovAge PACE Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health System MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$159.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.22
|
| Rate for Payer: Blue Shield of California Commercial |
$201.02
|
| Rate for Payer: Blue Shield of California EPN |
$131.27
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: Cigna of CA HMO |
$210.56
|
| Rate for Payer: Cigna of CA PPO |
$243.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$279.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$279.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$279.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: InnovAge PACE Commercial |
$164.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$230.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.30
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
| Rate for Payer: Riverside University Health System MISP |
$131.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.50
|
| Rate for Payer: United Healthcare All Other HMO |
$164.50
|
| Rate for Payer: United Healthcare HMO Rider |
$164.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$279.65
|
| Rate for Payer: Vantage Medical Group Senior |
$279.65
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$1,260.70 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$549.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$873.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$530.92
|
| Rate for Payer: Blue Shield of California Commercial |
$548.73
|
| Rate for Payer: Blue Shield of California EPN |
$358.89
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$578.56
|
| Rate for Payer: Cigna of CA PPO |
$668.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$587.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$587.60
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
915356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.35 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$2,459.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,498.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,522.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,636.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$3,298.90
|
| Rate for Payer: Cash Price |
$3,298.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,098.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,232.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,999.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,712.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,198.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,198.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$2,999.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
905356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.35 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$2,459.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,498.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,522.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,636.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$3,298.90
|
| Rate for Payer: Cash Price |
$3,298.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,098.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,232.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,999.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,712.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,198.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,198.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$2,999.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
905356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,636.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$3,298.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,285.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,712.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
|
|
HC LOCK ELBOW FOREARM COUNTER BAL
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT L6693
|
| Hospital Charge Code |
915356693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$5,398.20 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,636.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.99
|
| Rate for Payer: Cash Price |
$3,298.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,398.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,285.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,712.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.60
|
| Rate for Payer: Multiplan Commercial |
$4,498.50
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,964.35
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Central Health Plan Commercial |
$3.44
|
| Rate for Payer: Cigna of CA HMO |
$2.75
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.01
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.15
|
| Rate for Payer: United Healthcare HMO Rider |
$2.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3.65
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Central Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.65
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
|
OP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Adventist Health Commercial |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Central Health Plan Commercial |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$6.02
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Senior |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.93
|
| Rate for Payer: InnovAge PACE Commercial |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
| Rate for Payer: Riverside University Health System MISP |
$3.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.99
|
| Rate for Payer: Vantage Medical Group Senior |
$7.99
|
|
