|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.24
|
| Rate for Payer: Blue Shield of California Commercial |
$75.15
|
| Rate for Payer: Blue Shield of California EPN |
$49.08
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: InnovAge PACE Commercial |
$61.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.10
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Riverside University Health System MISP |
$49.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
OP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Adventist Health Commercial |
$83.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.26
|
| Rate for Payer: Blue Shield of California Commercial |
$255.15
|
| Rate for Payer: Blue Shield of California EPN |
$166.62
|
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: Central Health Plan Commercial |
$334.08
|
| Rate for Payer: Cigna of CA HMO |
$267.26
|
| Rate for Payer: Cigna of CA PPO |
$309.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$354.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Senior |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.84
|
| Rate for Payer: InnovAge PACE Commercial |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.32
|
| Rate for Payer: Multiplan Commercial |
$313.20
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
| Rate for Payer: Riverside University Health System MISP |
$167.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.80
|
| Rate for Payer: United Healthcare All Other HMO |
$208.80
|
| Rate for Payer: United Healthcare HMO Rider |
$208.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.96
|
| Rate for Payer: Vantage Medical Group Senior |
$354.96
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Adventist Health Commercial |
$83.52
|
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: Central Health Plan Commercial |
$334.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Senior |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$313.20
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
IP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$516.78 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$315.81
|
| Rate for Payer: Central Health Plan Commercial |
$459.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.84
|
| Rate for Payer: Multiplan Commercial |
$430.65
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
OP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$516.78 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$278.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.23
|
| Rate for Payer: Blue Shield of California Commercial |
$350.84
|
| Rate for Payer: Blue Shield of California EPN |
$229.11
|
| Rate for Payer: Cash Price |
$315.81
|
| Rate for Payer: Central Health Plan Commercial |
$459.36
|
| Rate for Payer: Cigna of CA HMO |
$367.49
|
| Rate for Payer: Cigna of CA PPO |
$424.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$488.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$488.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.78
|
| Rate for Payer: InnovAge PACE Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.94
|
| Rate for Payer: Multiplan Commercial |
$430.65
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
| Rate for Payer: Riverside University Health System MISP |
$229.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO |
$287.10
|
| Rate for Payer: United Healthcare HMO Rider |
$287.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$488.07
|
| Rate for Payer: Vantage Medical Group Senior |
$488.07
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.03
|
| Rate for Payer: Blue Shield of California Commercial |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: InnovAge PACE Commercial |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Medicare |
$15.35
|
| Rate for Payer: Riverside University Health System MISP |
$15.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC PYRUVATE CSF
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.03
|
| Rate for Payer: Blue Shield of California Commercial |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: InnovAge PACE Commercial |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Medicare |
$15.35
|
| Rate for Payer: Riverside University Health System MISP |
$15.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
915352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$529.00 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,112.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$529.00
|
| Rate for Payer: InnovAge PACE Commercial |
$947.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$529.00 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,112.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$529.00
|
| Rate for Payer: InnovAge PACE Commercial |
$947.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
915352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.26 |
| Max. Negotiated Rate |
$1,399.50 |
| Rate for Payer: Adventist Health Commercial |
$637.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$913.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.02
|
| Rate for Payer: Blue Shield of California EPN |
$783.72
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,399.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$690.06
|
| Rate for Payer: InnovAge PACE Commercial |
$777.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$1,166.25
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Riverside University Health System MISP |
$622.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
915352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$1,399.50 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.02
|
| Rate for Payer: Blue Shield of California EPN |
$783.72
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,399.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.00
|
| Rate for Payer: Multiplan Commercial |
$1,166.25
|
| Rate for Payer: Networks By Design Commercial |
$1,010.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$1,399.50 |
| Rate for Payer: Adventist Health Commercial |
$311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.02
|
| Rate for Payer: Blue Shield of California EPN |
$783.72
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,399.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.00
|
| Rate for Payer: Multiplan Commercial |
$1,166.25
|
| Rate for Payer: Networks By Design Commercial |
$1,010.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.26 |
| Max. Negotiated Rate |
$1,399.50 |
| Rate for Payer: Adventist Health Commercial |
$637.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$913.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.02
|
| Rate for Payer: Blue Shield of California EPN |
$783.72
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Cash Price |
$855.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Senior |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,399.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$690.06
|
| Rate for Payer: InnovAge PACE Commercial |
$777.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$962.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$1,166.25
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Riverside University Health System MISP |
$622.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.59
|
| Rate for Payer: United Healthcare All Other HMO |
$568.04
|
| Rate for Payer: United Healthcare HMO Rider |
$555.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
|
HC QUANTITATIVE GAIT ANALYSIS W/R
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
905370011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC QUANTITATIVE GAIT ANALYSIS W/R
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
905370011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$602.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.86
|
| Rate for Payer: Blue Shield of California Commercial |
$437.04
|
| Rate for Payer: Blue Shield of California EPN |
$285.84
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$460.80
|
| Rate for Payer: Cigna of CA PPO |
$532.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.90
|
| Rate for Payer: EPIC Health Plan Senior |
$171.78
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$281.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.78
|
| Rate for Payer: InnovAge PACE Commercial |
$257.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$230.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.19
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.78
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Prime Health Services Medicare |
$182.09
|
| Rate for Payer: Riverside University Health System MISP |
$188.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Vantage Medical Group Senior |
$188.96
|
|
|
HC RADIAL ARM SUPPORT,ADJT RANCHO
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT L3965
|
| Hospital Charge Code |
903203965
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,704.20 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,849.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,485.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,753.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,068.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,722.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,872.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,528.86
|
| Rate for Payer: Cash Price |
$3,485.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,387.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,387.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,704.20
|
| Rate for Payer: InnovAge PACE Commercial |
$3,169.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,436.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,436.60
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,535.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,169.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,169.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,169.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,169.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,387.30
|
|
|
HC RADIAL ARM SUPPORT,ADJT RANCHO
|
Facility
|
IP
|
$6,338.00
|
|
|
Service Code
|
CPT L3965
|
| Hospital Charge Code |
903203965
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,704.20 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Cash Price |
$3,485.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,704.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
|
|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
