|
HC LMA FASTRACH CHILD #3
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LMA FASTRACH CHILD #5
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
901698643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
OP
|
$1,119.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$1,260.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,198.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$873.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$661.11
|
| Rate for Payer: BCBS Transplant Transplant |
$671.40
|
| Rate for Payer: Blue Shield of California Commercial |
$691.54
|
| Rate for Payer: Blue Shield of California EPN |
$543.83
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$503.55
|
| Rate for Payer: Cash Price |
$503.55
|
| Rate for Payer: Central Health Plan Commercial |
$895.20
|
| Rate for Payer: Cigna of CA HMO |
$716.16
|
| Rate for Payer: Cigna of CA PPO |
$828.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$951.15
|
| Rate for Payer: Global Benefits Group Commercial |
$671.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,007.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$839.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$746.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$839.25
|
| Rate for Payer: Networks By Design Commercial |
$727.35
|
| Rate for Payer: Prime Health Services Commercial |
$951.15
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$671.40
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$671.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$671.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
IP
|
$1,119.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$1,007.10 |
| Rate for Payer: Cash Price |
$503.55
|
| Rate for Payer: Central Health Plan Commercial |
$895.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.60
|
| Rate for Payer: Galaxy Health WC |
$951.15
|
| Rate for Payer: Global Benefits Group Commercial |
$671.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,007.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$746.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.80
|
| Rate for Payer: Multiplan Commercial |
$839.25
|
| Rate for Payer: Networks By Design Commercial |
$727.35
|
| Rate for Payer: Prime Health Services Commercial |
$951.15
|
|
|
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: Blue Shield of California EPN |
$3,202.93
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$1,199.60
|
| 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
|
|
|
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 |
$2,099.30 |
| Max. Negotiated Rate |
$11,282.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,282.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,098.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,298.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,298.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,543.62
|
| Rate for Payer: BCBS Transplant Transplant |
$3,598.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,498.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,262.91
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,798.40
|
| Rate for Payer: Cigna of CA HMO |
$4,198.60
|
| Rate for Payer: Cigna of CA PPO |
$4,198.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$4,498.50
|
| Rate for Payer: IEHP medi-cal |
$2,099.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.18
|
| 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 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 |
$2,999.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,999.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,999.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,098.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,098.30
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
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: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.30
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| 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: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.44
|
| Rate for Payer: Cigna of CA HMO |
$2.75
|
| Rate for Payer: Cigna of CA PPO |
$3.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.72
|
| Rate for Payer: Galaxy Health WC |
$3.66
|
| Rate for Payer: Global Benefits Group Commercial |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.22
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.58
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$3.66
|
| Rate for Payer: Vantage Medical Group Senior |
$3.66
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
IP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Blue Shield of California Commercial |
$7.05
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 180
|
Facility
OP
|
$9.40
|
|
|
Service Code
|
CPT Q9965
|
| Hospital Charge Code |
909081004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$5.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$4.60
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.52
|
| Rate for Payer: Cigna of CA HMO |
$6.02
|
| Rate for Payer: Cigna of CA PPO |
$6.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7.05
|
| Rate for Payer: IEHP medi-cal |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.64
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$7.99
|
| Rate for Payer: Vantage Medical Group Senior |
$7.99
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 240
|
Facility
OP
|
$2.95
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
909081005
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.21
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$2.21
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.77
|
| Rate for Payer: Riverside University Health MISP |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Vantage Medical Group Senior |
$2.51
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 240
|
Facility
IP
|
$2.95
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
909081005
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$2.21
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.51
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 300
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081006
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 300
|
Facility
OP
|
$3.38
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081006
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.54
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: Riverside University Health MISP |
$1.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
IP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
|
|
HC LOCM (OMNIPAQUE-ISOVUE) 350-370
|
Facility
OP
|
$4.28
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081007
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$3.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.21
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: Riverside University Health MISP |
$1.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
IP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
|
|
HC LOCM (VISIPAQUE) 320 PER ML
|
Facility
OP
|
$4.27
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$2.73
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$2.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.20
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$3.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.56
|
| Rate for Payer: Riverside University Health MISP |
$1.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: Vantage Medical Group Senior |
$3.63
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.71
|
| Rate for Payer: BCBS Transplant Transplant |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$76.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.00
|
| Rate for Payer: IEHP medi-cal |
$49.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Riverside University Health MISP |
$56.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Other HMO |
$70.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC LO FLEXIBL L1-BELOW L5 PRE
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
905350625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Blue Shield of California EPN |
$74.76
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$98.00
|
| Rate for Payer: Cigna of CA PPO |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$70.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC LONG TONGUE STIRRUP ADDITION LE
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT L2265
|
| Hospital Charge Code |
905352265
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
